Atrioventricular node ablation is not a prerequisite for cardiac resynchronization therapy in patients with chronic atrial fibrillation

In drug-refractory heart failure, cardiac resynchronization therapy (CRT) is an established method in patients with sinus rhythm, severe reduced ejection fraction and broad QRS. Heart failure is known as a predisposition for atrial fibrillation (AF). However, the putative impact of atrioventricular node (AVN) ablation in chronic AF and CRT remains unclear. The aim of this study was to elucidate the effects of CRT in patients with chronic AF and the requirement for AVN ablation. A total of 100 patients were included in the retrospective study, 64 with sinus rhythm (SR) and 36 with chronic AF with a mean duration of 2.8 +/- 0.5 years. Clinical parameters, QRS duration and echocardiographic parameters were compared at baseline and after a follow-up of 11 +/- 0.34 months in patients with SR and in 27 patients with chronic AF who received optimized medication to control ventricular rate and nine patients who underwent an AVN ablation. Baseline characteristics between patients with SR or AF in the presence or absence of AVN ablation were comparable. In each group, a significant improvement of NYHA class, ejection fraction could be observed, with an analogous reduction of QRS duration and a diminished left ventricular end-diastolic dimension after 11 +/- 0.34 months of CRT. The present results demonstrate a comparable improvement in left ventricular function and functional capacity in all treated groups. In conclusion, AVN ablation is not a prerequisite for CRT in patients with severe heart failure and chronic AF.