[CRT-FORUM] 22E. AF, HF and CRT

[Francisco Leyva]

Dear all,

 

Observational data from our group (Khadjooi K, et al. Heart 2008;94:879-883) suggests that patients in AF benefit to the same degree as patients in SR, in terms of symptomatic as well as prognostic benefit. Gasparini M et al (J Am Coll Cardiol 2006;48:734-43) propose that all patients in AF should receive AV junction ablation. In balance, I would recommend that in patients with AF one should implant a CRT device and then uptitrate rate-slowing drugs to achieve a %biventricular pacing of at least 90%. If the patietns does not improve and 90% pacing cannot be achieved, I would then proceed to AV junction ablation. Admittedly, Gasparini M et al's data does suggest a prognostic benefit from AVJ ablation compared to medical treatment. This requires further investigation in a randomised study.

 

 

Dr Francisco Leyva (United Kingdom)

 
> From: crt-forum-request at crt-symposium.org
> Subject: Crt-forum Digest, Vol 2, Issue 6
> To: crt-forum at crt-symposium.org
> Date: Fri, 6 Mar 2009 12:00:08 -0300
> 
> 
> 
> Forum of the ISHNE Cardiac Resynchronization Therapy World-Wide Internet Symposium
> ______________________________________________________________________
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> Sponsored by Medtronic -- http://www.medtronicconnect.com
> ______________________________________________________________________
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> Today's Topics:
> 
> 1. Re: 21E. Multicenter Automatic Defibrillator Implant Trial
> II. Dr. Steinberg (CRT-INFO)
> 2. Re: 22E. AF, HF and CRT. Dr. Steinberg (CRT-INFO)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Fri, 06 Mar 2009 10:05:35 -0300
> From: CRT-INFO <info at crt-symposium.org>
> Subject: Re: [CRT-FORUM] 21E. Multicenter Automatic Defibrillator
> Implant Trial II. Dr. Steinberg
> To: crt-forum at crt-symposium.org
> Message-ID: <49B11F9F.1040509 at crt-symposium.org>
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
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> The MADIT II Study demonstrated conclusively that patients with prior MI 
> and low EF < 30% will have decreased mortality after ICD implantation. 
> The decrease in mortality, as expected, is due to reduction in sudden 
> cardiac death.
> 
> Jon Steinberg
> > What the Multicenter Automatic Defibrillator Implant Trial II study 
> > has revealed?
> >
> > Dr. E. Weber (Germany)
> >
> 
> 
> -- 
> Dr. Sergio Dubner
> President of Scientific Committee
> 
> Dr. Edgardo Schapachnik
> President of Steering Committee
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Fri, 06 Mar 2009 10:18:59 -0300
> From: CRT-INFO <info at crt-symposium.org>
> Subject: Re: [CRT-FORUM] 22E. AF, HF and CRT. Dr. Steinberg
> To: crt-forum at crt-symposium.org
> Message-ID: <49B122C3.7060905 at crt-symposium.org>
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
> 
> With the exception of a small substudy of MUSTIC, patients with AF and 
> the usual criteria for CRT have not been included in randomized clinical 
> trials. Some published observational studies suggest a similar benefit 
> for AF patients as for patients with sinus rhythm. However, other 
> studies raise some cautions and suggest that many AF patients do not 
> respond, possibly due to ineffective pacing, and instead AF patients 
> may require extra-ordinary steps to achieve rate control, including at 
> times AV junction ablation. For these reasons, it is reasonable to 
> implant CRT at present, but keep in mind the caveats described above. 
> Ideally, this population deserves a independent assessment in a 
> randomized clinical trial, not only to prove benefit, but to quantify 
> the frequency and magnitude of benefit, and potential special efforts to 
> achieve clinical response.
> 
> Jon Steinberg
> > AF is a major issue in HF patiens and its presence may interfere with 
> > optimal delivery of CRT. Do you think that up today, this is a clear 
> > indication for implantation or it must be assesed in randomized 
> > clinical trials?
> > Kenneth Woolfe, MD
> > Oakland, Ca
> >
> 
> 
> -- 
> Dr. Sergio Dubner
> President of Scientific Committee
> 
> Dr. Edgardo Schapachnik
> President of Steering Committee
> 
> 
> 
> ------------------------------
> 
> USER ID: crts
> PASSWORD: CRTS
> 
> End of Crt-forum Digest, Vol 2, Issue 6
> ***************************************