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Cardiac resynchronization therapy in atrial fibrillation

Author
Leslie A Saxon, MD
Section Editors
Wilson S Colucci, MD
Bradley P Knight, MD, FACC
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

In patients with significant dyssynchrony due to intrinsic conduction disease, cardiac resynchronization therapy (CRT) with biventricular pacing can improve ventricular synchrony. This is accomplished with an additional pacemaker lead implanted on the lateral left ventricle via a coronary vein. Among selected patients with heart failure (HF) who are in sinus rhythm, CRT improves cardiac performance, symptoms, and overall survival. (See "Cardiac resynchronization therapy in heart failure: Indications".)

The prevalence of atrial fibrillation (AF) in patients with HF varies with severity, ranging from 5 percent in patients with New York Heart Association (NYHA) functional class I HF to 40 percent in patients with NYHA class IV HF (table 1) [1].

The use of CRT in patients with AF will be reviewed here. The general use of CRT in patients in sinus rhythm and the rationale for and mechanisms of benefit of CRT are discussed separately. (See "Cardiac resynchronization therapy in heart failure: Indications" and "Rationale for and mechanisms of benefit of cardiac resynchronization therapy".)

CLINICAL SETTINGS FOR USE

Among patients with chronic atrial fibrillation (AF), cardiac resynchronization therapy (CRT) may be considered in three overlapping clinical settings: in the setting of atrioventricular (AV) block due to conduction system disease, following atrioventricular node ablation, and with systolic heart failure (HF).  

Atrioventricular block — Patients requiring pacemaker therapy for AV block caused by conduction system disease may avoid the negative effects of dyssynchrony that can be induced by right ventricular (RV) pacing via CRT. Evidence supporting this approach in patients with AF or sinus rhythm is discussed below. This clinical setting overlaps with the HF setting since the study population included patients with AV block with systolic dysfunction and HF. (See 'Patients requiring a pacemaker for AV block' below.)

                 

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 27 00:00:00 GMT+00:00 2014.
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