Atrial fibrillation node aBLAtion and clinical ouTcomEs in Cardiac Resynchronization Therapy (ABLATE-CRT) trial

Abstract

Background: Cardiac resynchronization therapy (CRT) is related with improved morbidity and mortality in left bundle branch block (LBBB) with and without atrial fibrillation (AF). No clear data is present in non-LBBB with AF Methods: Patients with AF and CRT (LBBB and non-LBBB) requiring atrioventricular node (AVN) ablation were assigned to AVN ablation and non-AVN ablation groups. Primary end-points were composite of all-cause mortality or heart failure hospitalization. Four-year follow-up was planned. Results: A total of 82 patients with CRT were included. Of these, 38 (46%) had LBBB with AF and 44 (54%) had non-LBBB with AFAblation was performed in 20 (24%) patients with LBBB and in 22 (27%) with non-LBBB. The mean age was 65 years. Males were 83%. Ischemic etiology was 51% and mean AF duration was 32 months. In all population the primary end-point of all cause mortality or heart failure hospitalization was lower in AVN ablation patients compared with non-AVN ablation patients (6.1% vs. 18.3%, p=0.007), driven by reduction in both mortality (2.4% vs. 9.8%, p=0.035) and hospitalization (6.1% vs. 15.9%, p=0.024). In LBBB patients, the primary end-point was also lower in AVN ablation patients compared with non-AVN ablation patients (5.3% vs. 21.1%, p=0.016), driven by reduction in both mortality (0% vs. 10.5%, p=0.026) and hospitalization (5.3% vs. 18.4%, p=0.036). In non-LBBB patients, the primary end-point was 6.8% and 15.9% in AVN ablation group and non-AVN ablation group, respectively. How-ever, this difference did not reach a statistical significance (p=0.150) (Figure). (Figure Presented) Conclusion: The morbidity and mortality benefit of AVN ablation was demonstrated in heterogeneous group of patients with or without LBBB and AFSubgroup analysis of patients with non-LBBB and AF did not, however, show the same benefit.