Clin Res Cardiol 107, Suppl 3, October 2018
CRT is More Often Used in Atrial Fibrillation Than Expected – Insights from the ESC/EHRA/HFA CRT Survey II.
D. Lawin1, C. Linde2, K. Dickstein3, C. Normand3, M. Gasparini4, C. Sticherling5, M. Gwechenberger6, M. Sterlinski7, C. Blomström-Lundqvist8, R. Sheahan9, G. Filippatos10, C. Stellbrink1
1Klinik f. Kardiologie und intern. Intensivmedizin, Klinikum Bielefeld Mitte, Bielefeld; 2Dept. of Cardiology, Karolinsky University Hospital, Stockholm, SE; 3Department of Cardiology, Stavanger University Hospital, Bergen, NO; 4Elettrofisiologia ed elettrostimolazione, Humanitas Research Hospital, Rozzano (Milan), IT; 5Abt. für Kardiologie, Universitätsspital Basel, Basel, CH; 6Universitätsklinik für Innere Medizin II, Medizinischer Universität Wien, Wien, AT; 7kardiologii, Szpital Ibis, Warsaw, PL; 8Department of Medical Sciences, Cardiology-Arrhythmia, University of Uppsala, Uppsala, SE; 9Cardiology Department, Beaumont Hospital, Dublin, IE; 10School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, GR;

Introduction: Previous data have shown that about 25% of patients (pts) receiving cardiac resynchronization therapy (CRT) have atrial fibrillation (AF) but AF pts have been underrepresented in randomized CRT trials. The ESC/EHRA/HFA CRT Survey II collected data on current CRT implantation practice in 42 European countries. This analysis focuses on CRT implantation practice with regard to the presence of AF. 

Methods and Results: Between October 2015 and January 2017, 11.088 pts with an initial implant or upgrade from a previous device were included in the survey. We analyzed 10843 pts with available data on AF presence. Overall, 4582 pts (42.2%) had AF. Permanent AF was present in 1889 pts. (42.4% of all AF pts), persistent AF in 994 (22.3%) and paroxysmal AF in 1548 pts (34.7%). AF pts. were older, had more advanced HF stage and more co-morbidities than pts. without AF (see table). There were also differences with regard to pacemaker dependency, CRT indication and device type implanted. Perioperative bleeding occurred slightly more often in AF pts. (1.3 vs. 0.8%, p=0.002) but the overall complication rate was not increased (5.2 vs. 5.8%, p=n.s.). Adverse events until discharge were more frequent in AF pts (5.4 vs. 4.3%, p=0.01), mostly due to increases in infections, worsening renal function and arrhythmias, but did not more often necessitate re-intervention (4.0 vs. 4.1%). 

Conclusion: The percentage of pts currently receiving CRT with concomitant AF is higher than previously reported. AF pts are older and sicker than pts receiving CRT without AF. Assuming a worse prognosis in the AF population, there is need for more prospective data on these pts.

 

Table: Baseline characteristics of CRT patients regarding presence of atrial fibrillation (AF). Values are means ± standard deviation (SD) or percentage (%). HD = heart disease. COPD = chronic obstructive pulmonary disease. CKD = chronic kidney disease. HF = heart failure. yr = year. PM = pacemaker. NYHA = New York Heart Association. BNP = brain natriuretic peptide. CRT = cardiac resynchronization therapy. ICD = implantable cardioverter defibrillator.
http://www.abstractserver.de/dgk2018/ht/abstracts//P541.htm