Türk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrowQRS: the APAF-CRT mortality trial (Dr. Göksel Cinier)

[Türkçe]

Turkish Society of Cardiology Young Cardiologists Bulletin Year: 4 Number: 2 / 2021

Turkish Society of Cardiology
Young Cardiologists
President
Dr. Muzaffer Değertekin

Coordinator for the
Board of Directors
Dr. Ertuğrul Okuyan

Coordinator for the
Board of Directors
Dr. Can Yücel Karabay

Members
Dr. Adem Aktan
Dr. Gülşah Aktüre
Dr. Bayram Arslan
Dr. İnanç Artaç
Dr. Ahmet Oğuz Aslan
Dr. Görkem Ayhan
Dr. Ahmet Anıl Başkurt
Dr. Özkan Bekler
Dr. Oğuzhan Birdal
Dr. Yusuf Bozkurt Şahin
Dr. Serkan Bulgurluoğlu
Dr. Ümit Bulut
Dr. Veysi Can
Dr. Mustafa Candemir
Dr. Murat Çap
Dr. Göksel Çinier
Dr. Ali Çoner
Dr. Yusuf Demir
Dr. Ömer Furkan Demir
Dr. Murat Demirci
Dr. Ayşe İrem Demirtola Mammadli
Dr. Süleyman Çağan Efe
Dr. Mehmet Akif Erdöl
Dr. Kubilay Erselcan
Dr. Kerim Esenboğa
Dr. Duygu Genç
Dr. Kemal Göçer
Dr. Elif Güçlü
Dr. Arda Güler
Dr. Duygu İnan
Dr. Hasan Burak İşleyen
Dr. Muzaffer Kahyaoğlu
Dr. Sedat Kalkan
Dr. Yücel Kanal
Dr. Özkan Karaca
Dr. Ahmet Karaduman
Dr. Mustafa Karanfil
Dr. Ayhan Kol
Dr. Fatma Köksal
Dr. Mevlüt Serdar Kuyumcu
Dr. Yunus Emre Özbebek
Dr. Ahmet Özderya
Dr. Yasin Özen
Dr. Ayşenur Özkaya İbiş
Dr. Çağlar Özmen
Dr. Selvi Öztaş
Dr. Hasan Sarı
Dr. Serkan Sivri
Dr. Ali Uğur Soysal
Dr. Hüseyin Tezcan
Dr. Nazlı Turan
Dr. Berat Uğuz
Dr. Örsan Deniz Urgun
Dr. İdris Yakut
Dr. Mustafa Yenerçağ
Dr. Mehmet Fatih Yılmaz
Dr. Yakup Yiğit
Dr. Mehmet Murat Yiğitbaşı

Bulletin Editors
Muzaffer Değertekin
Bülent Mutlu
Süleyman Çağan Efe
Alper Karakuş
Elif Hande Özcan Çetin

Contributors
Duygu İnan
Dursun Akaslan
Süleyman Çağan Efe
Alper Karakuş
Göksel Çinier
Elif Hande Özcan Çetin
Oğuzhan Birdal
Serhat Sığırcı
Ümit Yaşar Sinan
İbrahim Rencüzoğulları
Sedat Kalkan
Gökay Taylan
Murat Çap
Kerim Esenboğa
Mustafa Yılmaztepe
Emrah Erdoğan

AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrowQRS: the APAF-CRT mortality trialTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrowQRS: the APAF-CRT mortality trial (Dr. Göksel Cinier)

Reviewer: Dr. Göksel Çinier

Name of the Study: AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrowQRS: the APAF-CRT mortality trial

Published Congress: ESC 2021

Link : https://www.escardio.org/The-ESC/Press-Office/Press-releases/Ablation-and-biventricular-pacing-boosts-survival-in-selected-atrial-fibrillation-patients

Background:

Heart failure (AF) and concomitant atrial fibrillation (AF) poses a distinct challenge for clinicians. Although recent trials demonstrated mortality benefit with AF ablation in this subgroup of patients, best treatment option for those who could not undergo ablation is not known.

Objective:

The objective of the present study is to compare the efficacy of atrioventricular node ablation (AVJ) plus cardiac resynchronization therapy (CRT) with pharmacological rate control in patients with permanent AF and HF.

Methods:

Patients with symptomatic permanent AF (>6 months), narrow QRS (<110 ms) and at least one hospitalization for HF randomized either to AVJ+CRT or to pharmacological rate control. The primary endpoint was all-cause mortality.

Results:

Overall, 133 patients were randomized to either group. At interim analysis after a median of 29 months, primary endpoint occurred in 7(11%) and 20 (29%) patients in AVJ + CRT and pharmacological rate control groups respectively ([hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10–0.65; P = 0.004]. The benefit was consistent for those with LVEF <35% and > 35%.

Conclusion:

Compared to rate control, AVJ+CRT was superior in reducing mortality among patients with HF and permanent AF.

Interpretations:

APAF-CRT trial expanded the evidence that watchful waiting may not be the best options for patients with symptomatic AF (either paroxysmal, persistent or permanent) and HF. Either ablation for AF itself or for AV node should be preferred for reducing mortality.