CRT-P Implantation and Consecutive AV-node Ablation as Rescue Therapy for Refractory Atrial Fibrillation: A Single Center Experience

Aims: Cardiac resynchronization therapy (CRT-P) and atrioventricular node (AVN) ablation are a recommended treatment option for patients with atrial fibrillation (AF) refractory to medical treatment or pulmonary vein isolation. Its impact on cardiac function and patient outcome in patients with narrow QRS complex and LVEF > 35%, however, remains controversial. The aim of our study was to analyse the impact of CRT-P implantation and AVN ablation on NYHA class, left ejection fraction, EHRA score and left atrial diameter in high symptomatic patients with permanent or paroxysmal AF with narrow QRS complex and LVEF > 35%. Methods: A database of 24 consecutive patients with permanent AF who underwent AVN ablation after CRT-P implantation was analyzed retrospectively. All patients suffered from symptomatic permanent or paroxysmal AF refractory to medical rhythm and rate control or pulmonary vein ablation. Coronary and valvular heart disease was excluded in all patients. Follow up examinations were scheduled on regular intervals after 3 months up 4 years after AVN ablation. Left ventricular ejection fraction (LVEF), left atrial diameter (LAD), NYHA class, EHRA score and pro-BNP-level before procedures were compared to corresponding data on follow-up. Results: LVEF increased from 45.17 ± 10.95% to 53.63 ± 8.33% after CRT-P implantation and AVN ablation, NYHA class decreased 2.33 ± 0.64 to 1.21 ± 0.42, EHRA score decreased from 3.00 ± 0.51 to 1.13 ± 0.34. LAD decreased from 52.04 ± 3.39 mm to 48.96 ± 3.98 mm and pro- BNP decreased from 1257.38 ± 966.40 pg/ml to 579.04 ± 347.69 pg/ml. All changes were significant (p < 0.001). Conclusion: In this retrospective single-centre analysis, we provide striking evidence for significant functional improvement und symptomatic benefit in patients with symptomatic and refractory atrial fibrillation with narrow QRS complex and LVEF > 35% after CRT-P implantation and AVN-ablation procedures.