Ablate and Pace for Atrial Fibrillation - APAF-CRT

Aug 26, 2018
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Presenter/Author:
Michele Brignole, MD
Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
08/26/2018
Date Published:
08/26/2018
Date Updated:
08/26/2018
Original Posted Date:
08/26/2018
References

Contribution To Literature:

The APAF-CRT trial showed that AV node ablation/cardiac resynchronization therapy was superior at preventing heart failure–related morbidity/mortality.

Description:

The goal of the trial was to evaluate atrioventricular (AV) node ablation plus cardiac resynchronization therapy compared with medical therapy among patients with permanent atrial fibrillation.

Study Design

  • Randomized
  • Parallel
  • Stratified

Patients with permanent atrial fibrillation and narrow QRS were randomized to AV node ablation and cardiac resynchronization therapy (n = 50) versus medical therapy (n = 52).

Inclusion criteria:

  • Symptomatic permanent atrial fibrillation >6 months in duration not appropriate for atrial fibrillation ablation
  • Narrow QRS (≤110 ms)
  • ≥1 heart failure hospitalization(s) in the previous year

Exclusion criteria:

  • New York Heart Association class IV and systolic blood pressure ≤80 mm Hg
  • Severe concomitant noncardiac disease
  • Need for surgical procedure
  • Myocardial infarction within the last 3 months
  • Previously implanted devices

Principal Findings:

The primary outcome, heart failure mortality, hospitalization for failure, or worsening heart failure, occurred in 30% of the cardiac AV node ablation/cardiac resynchronization group compared with 45% of the medical therapy group (p = 0.01).

Secondary outcomes:

  • Symptom and physical limitation score: 16.3 with cardiac resynchronization vs. 10.5 with medical therapy

Interpretation:

Among patients with atrial fibrillation and narrow QRS, AV node ablation plus cardiac resynchronization therapy was beneficial compared with medical therapy. This strategy was associated with reduction in heart failure–related morbidity and mortality. Patients who underwent AV node ablation plus cardiac resynchronization therapy experienced a greater symptom and physical limitation score.

References:

Presented by Dr. Michele Brignole at the European Society of Cardiology Congress, Munich, Germany, August 26, 2018.

Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: ESC Congress, ESC18, Arrhythmias, Cardiac, Atrial Fibrillation, Atrioventricular Node, Cardiac Resynchronization Therapy, Catheter Ablation, Geriatrics, Heart Failure, Secondary Prevention


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