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Brignole M, Pentimalli F, Palmisano P, et al. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021;42(46):4731-4739doi: 10.1093/eurheartj/ehab569.
Brignole, M., Pentimalli, F., Palmisano, P., Landolina, M., Quartieri, F., Occhetta, E., Calò, L., Mascia, G., Mont, L., Vernooy, K., van Dijk, V., Allaart, C., Fauchier, L., Gasparini, M., Parati, G., Soranna, D., Rienstra, M., Van Gelder, I. C. (2021). AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. European heart journal, 42(46), 4731-4739. https://doi.org/10.1093/eurheartj/ehab569
Brignole, Michele, et al. "AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial." European heart journal vol. 42,46 (2021): 4731-4739. doi: https://doi.org/10.1093/eurheartj/ehab569
Brignole M, Pentimalli F, Palmisano P, Landolina M, Quartieri F, Occhetta E, Calò L, Mascia G, Mont L, Vernooy K, van Dijk V, Allaart C, Fauchier L, Gasparini M, Parati G, Soranna D, Rienstra M, Van Gelder IC. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021 Dec 07;42(46):4731-4739. doi: 10.1093/eurheartj/ehab569. PMID: 34453840.
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Eur Heart J. 2021 Dec 07;42(46):4731-4739. doi: 10.1093/eurheartj/ehab569.

AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial.

European heart journal

Michele Brignole, Francesco Pentimalli, Pietro Palmisano, Maurizio Landolina, Fabio Quartieri, Eraldo Occhetta, Leonardo Calò, Giuseppe Mascia, Lluis Mont, Kevin Vernooy, Vincent van Dijk, Cor Allaart, Laurent Fauchier, Maurizio Gasparini, Gianfranco Parati, Davide Soranna, Michiel Rienstra, Isabelle C Van Gelder,

Affiliations

  1. Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy.
  2. Department of Cardiology, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Piazzale Brescia 20, 20149 Milan, Italy.
  3. Department of Cardiology, Ospedale S. Paolo, Savona, Italy.
  4. Department of Cardiology, Ospedale Panico, Tricase, Italy.
  5. Department of Cardiology, Ospedale Maggiore, Crema, Italy.
  6. Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy.
  7. Department of Cardiology, Ospedale Maggiore della Carità, Novara, Italy.
  8. Department of Cardiology, Policlinico Casilino, Roma, Italy.
  9. Department of Cardiology, Ospedale San Giovanni di Dio, Firenze, Italy.
  10. Department of Cardiology, Hospital Clinic, Barcelona, Spain.
  11. Department of Cardiology, University Medical Center, Maastricht, The Netherlands.
  12. Department of Cardiology, University Medical Center, Nieuwegein, The Netherlands.
  13. Department of Cardiology, University Medical Center, Amsterdam, The Netherlands.
  14. Department of Cardiology, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France.
  15. Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy.
  16. Department of Cardiology, University of Milano Bicocca, Milan, Italy.
  17. Department of Cardiology, IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy.
  18. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 34453840 DOI: 10.1093/eurheartj/ehab569

Abstract

AIMS : In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation + CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown.

METHODS AND RESULTS : In this international, open-label, blinded outcome trial, we randomly assigned patients with severely symptomatic permanent AF >6 months, narrow QRS (≤110 ms) and at least one HF hospitalization in the previous year to Ablation + CRT or to pharmacological rate control. We hypothesized that Ablation + CRT is superior in reducing the primary endpoint of all-cause mortality. A total of 133 patients were randomized. The mean age was 73 ± 10 years, and 62 (47%) were females. The trial was stopped for efficacy at interim analysis after a median of 29 months of follow-up per patient. The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10-0.65; P = 0.004]. The estimated death rates at 2 years were 5% and 21%, respectively; at 4 years, 14% and 41%. The benefit of Ablation + CRT of all-cause mortality was similar in patients with ejection fraction (EF) ≤35% and in those with >35%. The secondary endpoint combining all-cause mortality or HF hospitalization was significantly lower in the Ablation + CRT arm [18 (29%) vs. 36 (51%); HR 0.40, 95% CI 0.22-0.73; P = 0.002].

CONCLUSIONS : Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF.

STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT02137187.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Keywords: AV node ablation; Atrial fibrillation; Cardiac resynchronization therapy; Catheter ablation; Heart failure; QRS width

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