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Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?

BACKGROUND: Cardiac resynchronization therapy (CRT) is widely used in atrial fibrillation (AF) patients and could impact rhythm stability. HYPOTHESIS: We aimed to identify predictors of sinus rhythm (SR) stability or AF progression in a real‐word cohort of CRT‐AF patients. METHODS: From 330 consecut...

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Autores principales: Nedios, Sotirios, Doering, Michael, Darma, Angeliki, Lucas, Johannes, Dinov, Borislav, Arya, Arash, Dagres, Nikolaos, Hindricks, Gerhard, Bollmann, Andreas, Richter, Sergio, Bode, Kerstin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852157/
https://www.ncbi.nlm.nih.gov/pubmed/33295029
http://dx.doi.org/10.1002/clc.23527
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author Nedios, Sotirios
Doering, Michael
Darma, Angeliki
Lucas, Johannes
Dinov, Borislav
Arya, Arash
Dagres, Nikolaos
Hindricks, Gerhard
Bollmann, Andreas
Richter, Sergio
Bode, Kerstin
author_facet Nedios, Sotirios
Doering, Michael
Darma, Angeliki
Lucas, Johannes
Dinov, Borislav
Arya, Arash
Dagres, Nikolaos
Hindricks, Gerhard
Bollmann, Andreas
Richter, Sergio
Bode, Kerstin
author_sort Nedios, Sotirios
collection PubMed
description BACKGROUND: Cardiac resynchronization therapy (CRT) is widely used in atrial fibrillation (AF) patients and could impact rhythm stability. HYPOTHESIS: We aimed to identify predictors of sinus rhythm (SR) stability or AF progression in a real‐word cohort of CRT‐AF patients. METHODS: From 330 consecutive implantable cardioverter‐defibrillator implantations due to ischemic or dilated cardiomyopathy, 65 (20%) patients with AF history (paroxysmal, n = 32) underwent a CRT implantation with an atrial electrode and were regularly followed every 4–6 months. Rhythm restoration was attempted for most AF patients based on symptoms, biventricular pacing (BP), and lack of thrombi. RESULTS: After 33 months, 18 (28%) patients progressed to permanent mode switch (MS≥99%) and 20 (31%) patients had stable SR (MS < 1%). Logistic regression showed that history of persistent AF (OR: 8.01, 95%CI: 2.0–31.7, p = .003) is associated with higher risk of permanent MS. In persistent AF patients, a bigger left atrium (OR: 1.2 per mm, 95%CI: 1.03–1.4, p = .025) and older age (OR: 1.15 per life‐year, 95%CI: 1.01–1.3, p = .032) were predictors of future permanent MS. Paroxysmal AF at implantation (OR: 5.96, 95%CI: 1.6–21.9, p = .007) and increased BP (OR: 1.4 per 1%, 95%CI: 1.05–1.89, p = .02) were associated with stable SR. In persistent AF patients, stable SR correlated with higher BP (98 ± 2 vs. 92 ± 8%, p < .001). CONCLUSION: In patients with AF undergoing CRT implantation, persistent AF, LA dilatation and advanced age relate to future permanent MS (AF), whereas high BP promotes SR stability. These findings could facilitate the management of CRT‐AF patients and guide therapy in order to maximize its effect on rhythm.
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spelling pubmed-78521572021-02-05 Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead? Nedios, Sotirios Doering, Michael Darma, Angeliki Lucas, Johannes Dinov, Borislav Arya, Arash Dagres, Nikolaos Hindricks, Gerhard Bollmann, Andreas Richter, Sergio Bode, Kerstin Clin Cardiol Clinical Investigations BACKGROUND: Cardiac resynchronization therapy (CRT) is widely used in atrial fibrillation (AF) patients and could impact rhythm stability. HYPOTHESIS: We aimed to identify predictors of sinus rhythm (SR) stability or AF progression in a real‐word cohort of CRT‐AF patients. METHODS: From 330 consecutive implantable cardioverter‐defibrillator implantations due to ischemic or dilated cardiomyopathy, 65 (20%) patients with AF history (paroxysmal, n = 32) underwent a CRT implantation with an atrial electrode and were regularly followed every 4–6 months. Rhythm restoration was attempted for most AF patients based on symptoms, biventricular pacing (BP), and lack of thrombi. RESULTS: After 33 months, 18 (28%) patients progressed to permanent mode switch (MS≥99%) and 20 (31%) patients had stable SR (MS < 1%). Logistic regression showed that history of persistent AF (OR: 8.01, 95%CI: 2.0–31.7, p = .003) is associated with higher risk of permanent MS. In persistent AF patients, a bigger left atrium (OR: 1.2 per mm, 95%CI: 1.03–1.4, p = .025) and older age (OR: 1.15 per life‐year, 95%CI: 1.01–1.3, p = .032) were predictors of future permanent MS. Paroxysmal AF at implantation (OR: 5.96, 95%CI: 1.6–21.9, p = .007) and increased BP (OR: 1.4 per 1%, 95%CI: 1.05–1.89, p = .02) were associated with stable SR. In persistent AF patients, stable SR correlated with higher BP (98 ± 2 vs. 92 ± 8%, p < .001). CONCLUSION: In patients with AF undergoing CRT implantation, persistent AF, LA dilatation and advanced age relate to future permanent MS (AF), whereas high BP promotes SR stability. These findings could facilitate the management of CRT‐AF patients and guide therapy in order to maximize its effect on rhythm. Wiley Periodicals, Inc. 2020-12-09 /pmc/articles/PMC7852157/ /pubmed/33295029 http://dx.doi.org/10.1002/clc.23527 Text en © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Investigations
Nedios, Sotirios
Doering, Michael
Darma, Angeliki
Lucas, Johannes
Dinov, Borislav
Arya, Arash
Dagres, Nikolaos
Hindricks, Gerhard
Bollmann, Andreas
Richter, Sergio
Bode, Kerstin
Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title_full Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title_fullStr Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title_full_unstemmed Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title_short Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?
title_sort predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: when should we use an atrial lead?
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852157/
https://www.ncbi.nlm.nih.gov/pubmed/33295029
http://dx.doi.org/10.1002/clc.23527
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