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PLoS One. 2019 Jan 11;14(1):e0210603. doi: 10.1371/journal.pone.0210603. eCollection 2019.

Outcomes of cardiac resynchronization therapy in patients with atrial fibrillation accompanied by slow ventricular response.

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Division of Cardiology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.


It remains unclear as to whether cardiac resynchronization therapy (CRT) would be as effective in patients with atrial fibrillation (AF) accompanied by slow ventricular response (AF-SVR, < 60 beats/min) as in those with sinus rhythm (SR). Echocardiographic reverse remodeling was compared between AF-SVR patients (n = 17) and those with SR (n = 88) at six months and 12 months after CRT treatment. We also evaluated the changes in QRS duration; New York Heart Association (NYHA) functional class; and long-term composite clinical outcomes including cardiac death, heart transplantation, and heart failure (HF)-related hospitalization. Left ventricular pacing sites and biventricular pacing percentages were not significantly different between the AF-SVR and SR groups. However, heart rate increase after CRT was significantly greater in the AF-SVR group than in the SR group (P < 0.001). At six and 12 months postoperation, both groups showed a comparable improvement in NYHA class; QRS narrowing; and echocardiographic variables including left ventricular end-systolic volume, left ventricular ejection fraction, and left atrial volume index. Over the median follow-up duration of 1.6 (interquartile range: 0.8-2.2) years, no significant between-group differences were observed regarding the rates of long-term composite clinical events (35% versus 24%; hazard ratio: 1.71; 95% confidence interval: 0.23-12.48; P = 0.60). CRT implantation provided comparable beneficial effects for patients with AF-SVR as compared with those with SR, by correcting electrical dyssynchrony and increasing biventricular pacing rate, in terms of QRS narrowing, symptom improvement, ventricular reverse remodeling, and long-term clinical outcomes.

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