Outcomes of cardiac resynchronization therapy in patients with intermittent atrial fibrillation or atrial flutter in the COMPANION trial

Heart Rhythm. 2017 Jun;14(6):858-865. doi: 10.1016/j.hrthm.2017.03.024. Epub 2017 Mar 18.

Abstract

Background: Controlled clinical trial data are lacking for cardiac resynchronization therapy (CRT) outcomes in patients with advanced heart failure (HF) from reduced left ventricular ejection fraction (HFrEF) and intermittent atrial fibrillation or flutter (IAF/AFL).

Objective: The purpose of this study was to describe CRT outcomes in patients with IAF/AFL and advanced HF.

Methods: HF outcomes in patients in the COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trial with New York Heart Association class III or IV HFrEF, left ventricular ejection fraction ≤0.35, sinus rhythm at randomization, and no history of baseline arrhythmia were compared with those with a history of IAF/AFL.

Results: In those with no history of baseline arrhythmia (n = 887), compared with optimal pharmacological therapy (OPT) with no CRT, the CRT + OPT arms exhibited a significant reduction in the end points of death or any hospitalization (hazard ratio [HR] 0.73 [95% Confidence Interval (CI): 0.60 to 0.89]; P = .002) and death or HF hospitalization (HR 0.53 [95% CI: 0.41 to 0.68]; P < .001). In contrast, in the IAF/AFL subgroup (n = 293), CRT did not result in improved outcomes compared with OPT (death or any hospitalization: HR 1.16 [95% CI: 0.83 to 1.63]; P = .38; death or HF hospitalization: HR 0.97 [95% CI: 0.64 to 1.46]; P = .88). The interaction between history of AF/AFL and CRT was statistically significant for both outcomes (P < .05).

Conclusion: In the COMPANION trial, patients with moderate to severe HFrEF and a history of IAF/AFL had no benefit from CRT.

Keywords: Atrial fibrillation; Biventricular pacing; Cardiac resynchronization therapy; Heart failure; Intermittent atrial fibrillation or flutter.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Atrial Flutter / etiology
  • Atrial Flutter / physiopathology
  • Atrial Flutter / therapy*
  • Cardiac Resynchronization Therapy / methods*
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Failure / complications*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Humans
  • Male
  • Stroke Volume / physiology*
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left / physiology*