@article{73ff947581a44e48b7c1b194d5129bd3,
title = "AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial",
abstract = "Aims In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation + CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown.Methods and results In this international, open-label, blinded outcome trial, we randomly assigned patients with severely symptomatic permanent AF >6 months, narrow QRS (<= 110 ms) and at least one HF hospitalization in the previous year to Ablation + CRT or to pharmacological rate control. We hypothesized that Ablation + CRT is superior in reducing the primary endpoint of all-cause mortality. A total of 133 patients were randomized. The mean age was 73 +/- 10 years, and 62 (47%) were females. The trial was stopped for efficacy at interim analysis after a median of 29 months of follow-up per patient. The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10-0.65; P= 0.004]. The estimated death rates at 2 years were 5% and 21%, respectively; at 4 years, 14% and 41%. The benefit of Ablation + CRT of all-cause mortality was similar in patients with ejection fraction (EF) <= 35% and in those with >35%. The secondary endpoint combining all-cause mortality or HF hospitalization was significantly lower in the Ablation + CRT arm [18 (29%) vs. 36 (51%); HR 0.40, 95% CI 0.22-0.73; P = 0.002].Conclusions Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF.[GRAPHICS].",
keywords = "Atrial fibrillation, Heart failure, Cardiac resynchronization therapy, Catheter ablation, AV node ablation, QRS width, HEART-FAILURE, ATRIOVENTRICULAR NODE, THERAPY, OUTCOMES, RHYTHM",
author = "M. Brignole and F. Pentimalli and P. Palmisano and M. Landolina and F. Quartieri and E. Occhetta and L. Calo and G. Mascia and L. Mont and K. Vernooy and {van Dijk}, V. and C. Allaart and L. Fauchier and M. Gasparini and G. Parati and D. Soranna and M. Rienstra and {Van Gelder}, I.C. and {APAF-CRT Trial Investigators}",
note = "Publisher Copyright: {\textcopyright} 2021 Published on behalf of the European Society of Cardiology. All rights reserved. ",
year = "2021",
month = dec,
day = "7",
doi = "10.1093/eurheartj/ehab569",
language = "English",
volume = "42",
pages = "4731--4739",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "46",
}