Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation
Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm. Hea...
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| Veröffentlicht in: | Europace (London, England) England), 2024-07, Vol.26 (7) |
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| creator | Merkely, Béla Hatala, Robert Merkel, Eperke Szigeti, Mátyás Veres, Boglárka Fábián, Alexandra Osztheimer, István Gellér, László Sasov, Michal Wranicz, Jerzy K Földesi, Csaba Duray, Gábor Solomon, Scott D Kutyifa, Valentina Kovács, Attila Kosztin, Annamária |
| description | Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.
Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or |
| doi_str_mv | 10.1093/europace/euae179 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed</sourceid><recordid>TN_cdi_pubmed_primary_39082726</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>39082726</sourcerecordid><originalsourceid>FETCH-pubmed_primary_390827263</originalsourceid><addsrcrecordid>eNqFjkFrAjEUhINQ1LbePZX3B6zZLLrNtaXiD_Aub_Vl90nMLi9JS_99U2jBW08zzHwwo9Sy0s-VtvWasgwjnqgYpKqxEzWvNrVZGW3NTN3HeNFaN8ZupmpWW_1iGrOdK3mlQI5ThMFBHjvBM4cOhLs-wQeFJHzKHgXSAC3fBmXrh-QAPaEkcMg-C5U8ccEifHLqAQuPHhy3wt6XagiP6s6hj7T41Qf1tHs_vO1XY26vdD6OwleUr-Pfyfpf4BtMzFGs</addsrcrecordid><sourcetype>Index Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation</title><source>Oxford Journals Open Access Collection</source><source>MEDLINE</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Merkely, Béla ; Hatala, Robert ; Merkel, Eperke ; Szigeti, Mátyás ; Veres, Boglárka ; Fábián, Alexandra ; Osztheimer, István ; Gellér, László ; Sasov, Michal ; Wranicz, Jerzy K ; Földesi, Csaba ; Duray, Gábor ; Solomon, Scott D ; Kutyifa, Valentina ; Kovács, Attila ; Kosztin, Annamária</creator><creatorcontrib>Merkely, Béla ; Hatala, Robert ; Merkel, Eperke ; Szigeti, Mátyás ; Veres, Boglárka ; Fábián, Alexandra ; Osztheimer, István ; Gellér, László ; Sasov, Michal ; Wranicz, Jerzy K ; Földesi, Csaba ; Duray, Gábor ; Solomon, Scott D ; Kutyifa, Valentina ; Kovács, Attila ; Kosztin, Annamária</creatorcontrib><description>Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.
Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.</description><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euae179</identifier><identifier>PMID: 39082726</identifier><language>eng</language><publisher>England</publisher><subject>Aged ; Aged, 80 and over ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - mortality ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - therapy ; Cardiac Resynchronization Therapy - methods ; Cardiac Resynchronization Therapy Devices ; Defibrillators, Implantable ; Electric Countershock - adverse effects ; Electric Countershock - instrumentation ; Female ; Heart Failure - mortality ; Heart Failure - physiopathology ; Heart Failure - therapy ; Hospitalization - statistics & numerical data ; Humans ; Male ; Middle Aged ; Risk Factors ; Stroke Volume ; Time Factors ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Function, Right</subject><ispartof>Europace (London, England), 2024-07, Vol.26 (7)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0001-9674-2540 ; 0000-0002-8449-0638 ; 0000-0001-6514-0723 ; 0009-0005-1878-9286 ; 0000-0001-6647-2623 ; 0000-0001-6802-6360 ; 0000-0002-5033-117X ; 0000-0002-0016-289X ; 0000-0001-6817-1437 ; 0000-0002-6335-0273 ; 0000-0003-1286-6576 ; 0000-0003-3698-9597 ; 0000-0002-8209-990X ; 0000-0003-2320-6434 ; 0000-0002-3889-3794 ; 0000-0001-7250-7888</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39082726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Merkely, Béla</creatorcontrib><creatorcontrib>Hatala, Robert</creatorcontrib><creatorcontrib>Merkel, Eperke</creatorcontrib><creatorcontrib>Szigeti, Mátyás</creatorcontrib><creatorcontrib>Veres, Boglárka</creatorcontrib><creatorcontrib>Fábián, Alexandra</creatorcontrib><creatorcontrib>Osztheimer, István</creatorcontrib><creatorcontrib>Gellér, László</creatorcontrib><creatorcontrib>Sasov, Michal</creatorcontrib><creatorcontrib>Wranicz, Jerzy K</creatorcontrib><creatorcontrib>Földesi, Csaba</creatorcontrib><creatorcontrib>Duray, Gábor</creatorcontrib><creatorcontrib>Solomon, Scott D</creatorcontrib><creatorcontrib>Kutyifa, Valentina</creatorcontrib><creatorcontrib>Kovács, Attila</creatorcontrib><creatorcontrib>Kosztin, Annamária</creatorcontrib><title>Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.
Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac Resynchronization Therapy - methods</subject><subject>Cardiac Resynchronization Therapy Devices</subject><subject>Defibrillators, Implantable</subject><subject>Electric Countershock - adverse effects</subject><subject>Electric Countershock - instrumentation</subject><subject>Female</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - therapy</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Function, Right</subject><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFjkFrAjEUhINQ1LbePZX3B6zZLLrNtaXiD_Aub_Vl90nMLi9JS_99U2jBW08zzHwwo9Sy0s-VtvWasgwjnqgYpKqxEzWvNrVZGW3NTN3HeNFaN8ZupmpWW_1iGrOdK3mlQI5ThMFBHjvBM4cOhLs-wQeFJHzKHgXSAC3fBmXrh-QAPaEkcMg-C5U8ccEifHLqAQuPHhy3wt6XagiP6s6hj7T41Qf1tHs_vO1XY26vdD6OwleUr-Pfyfpf4BtMzFGs</recordid><startdate>20240702</startdate><enddate>20240702</enddate><creator>Merkely, Béla</creator><creator>Hatala, Robert</creator><creator>Merkel, Eperke</creator><creator>Szigeti, Mátyás</creator><creator>Veres, Boglárka</creator><creator>Fábián, Alexandra</creator><creator>Osztheimer, István</creator><creator>Gellér, László</creator><creator>Sasov, Michal</creator><creator>Wranicz, Jerzy K</creator><creator>Földesi, Csaba</creator><creator>Duray, Gábor</creator><creator>Solomon, Scott D</creator><creator>Kutyifa, Valentina</creator><creator>Kovács, Attila</creator><creator>Kosztin, Annamária</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><orcidid>https://orcid.org/0000-0001-9674-2540</orcidid><orcidid>https://orcid.org/0000-0002-8449-0638</orcidid><orcidid>https://orcid.org/0000-0001-6514-0723</orcidid><orcidid>https://orcid.org/0009-0005-1878-9286</orcidid><orcidid>https://orcid.org/0000-0001-6647-2623</orcidid><orcidid>https://orcid.org/0000-0001-6802-6360</orcidid><orcidid>https://orcid.org/0000-0002-5033-117X</orcidid><orcidid>https://orcid.org/0000-0002-0016-289X</orcidid><orcidid>https://orcid.org/0000-0001-6817-1437</orcidid><orcidid>https://orcid.org/0000-0002-6335-0273</orcidid><orcidid>https://orcid.org/0000-0003-1286-6576</orcidid><orcidid>https://orcid.org/0000-0003-3698-9597</orcidid><orcidid>https://orcid.org/0000-0002-8209-990X</orcidid><orcidid>https://orcid.org/0000-0003-2320-6434</orcidid><orcidid>https://orcid.org/0000-0002-3889-3794</orcidid><orcidid>https://orcid.org/0000-0001-7250-7888</orcidid></search><sort><creationdate>20240702</creationdate><title>Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation</title><author>Merkely, Béla ; Hatala, Robert ; Merkel, Eperke ; Szigeti, Mátyás ; Veres, Boglárka ; Fábián, Alexandra ; Osztheimer, István ; Gellér, László ; Sasov, Michal ; Wranicz, Jerzy K ; Földesi, Csaba ; Duray, Gábor ; Solomon, Scott D ; Kutyifa, Valentina ; Kovács, Attila ; Kosztin, Annamária</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-pubmed_primary_390827263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - therapy</topic><topic>Cardiac Resynchronization Therapy - methods</topic><topic>Cardiac Resynchronization Therapy Devices</topic><topic>Defibrillators, Implantable</topic><topic>Electric Countershock - adverse effects</topic><topic>Electric Countershock - instrumentation</topic><topic>Female</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - therapy</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Merkely, Béla</creatorcontrib><creatorcontrib>Hatala, Robert</creatorcontrib><creatorcontrib>Merkel, Eperke</creatorcontrib><creatorcontrib>Szigeti, Mátyás</creatorcontrib><creatorcontrib>Veres, Boglárka</creatorcontrib><creatorcontrib>Fábián, Alexandra</creatorcontrib><creatorcontrib>Osztheimer, István</creatorcontrib><creatorcontrib>Gellér, László</creatorcontrib><creatorcontrib>Sasov, Michal</creatorcontrib><creatorcontrib>Wranicz, Jerzy K</creatorcontrib><creatorcontrib>Földesi, Csaba</creatorcontrib><creatorcontrib>Duray, Gábor</creatorcontrib><creatorcontrib>Solomon, Scott D</creatorcontrib><creatorcontrib>Kutyifa, Valentina</creatorcontrib><creatorcontrib>Kovács, Attila</creatorcontrib><creatorcontrib>Kosztin, Annamária</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Merkely, Béla</au><au>Hatala, Robert</au><au>Merkel, Eperke</au><au>Szigeti, Mátyás</au><au>Veres, Boglárka</au><au>Fábián, Alexandra</au><au>Osztheimer, István</au><au>Gellér, László</au><au>Sasov, Michal</au><au>Wranicz, Jerzy K</au><au>Földesi, Csaba</au><au>Duray, Gábor</au><au>Solomon, Scott D</au><au>Kutyifa, Valentina</au><au>Kovács, Attila</au><au>Kosztin, Annamária</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2024-07-02</date><risdate>2024</risdate><volume>26</volume><issue>7</issue><eissn>1532-2092</eissn><abstract>Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.
Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.</abstract><cop>England</cop><pmid>39082726</pmid><doi>10.1093/europace/euae179</doi><orcidid>https://orcid.org/0000-0001-9674-2540</orcidid><orcidid>https://orcid.org/0000-0002-8449-0638</orcidid><orcidid>https://orcid.org/0000-0001-6514-0723</orcidid><orcidid>https://orcid.org/0009-0005-1878-9286</orcidid><orcidid>https://orcid.org/0000-0001-6647-2623</orcidid><orcidid>https://orcid.org/0000-0001-6802-6360</orcidid><orcidid>https://orcid.org/0000-0002-5033-117X</orcidid><orcidid>https://orcid.org/0000-0002-0016-289X</orcidid><orcidid>https://orcid.org/0000-0001-6817-1437</orcidid><orcidid>https://orcid.org/0000-0002-6335-0273</orcidid><orcidid>https://orcid.org/0000-0003-1286-6576</orcidid><orcidid>https://orcid.org/0000-0003-3698-9597</orcidid><orcidid>https://orcid.org/0000-0002-8209-990X</orcidid><orcidid>https://orcid.org/0000-0003-2320-6434</orcidid><orcidid>https://orcid.org/0000-0002-3889-3794</orcidid><orcidid>https://orcid.org/0000-0001-7250-7888</orcidid></addata></record> |
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| ispartof | Europace (London, England), 2024-07, Vol.26 (7) |
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| source | Oxford Journals Open Access Collection; MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - mortality Atrial Fibrillation - physiopathology Atrial Fibrillation - therapy Cardiac Resynchronization Therapy - methods Cardiac Resynchronization Therapy Devices Defibrillators, Implantable Electric Countershock - adverse effects Electric Countershock - instrumentation Female Heart Failure - mortality Heart Failure - physiopathology Heart Failure - therapy Hospitalization - statistics & numerical data Humans Male Middle Aged Risk Factors Stroke Volume Time Factors Treatment Outcome Ventricular Function, Left Ventricular Function, Right |
| title | Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation |
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