Heart failure & cardiomyopathies
Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation
Authors' conclusion
In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.
Study context
- Population
- HFrEF patients with previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden, by baseline rhythm (AF or sinus rhythm (SR))131 (36%) with AF
- Participants
- 215 vs 145
- Comparison
- CRT with defibrillator (CRT-D) upgrade vs ICD, in AF vs SR
- CRT-Dn = 215
- ICDn = 145reference
- Primary endpoint
- HF hospitalization, all-cause mortality, or <15% reduction of LV end-systolic volume
- Follow-up
- Mean 12.4 months
Methodological detailssubgroup analysis by baseline rhythm
- Subgroup analysis by baseline rhythm
Primary result
As reported in the abstract
Primary composite, by baseline rhythm
CRT-D vs ICDAdjusted odds ratio (95% CI)P value
AF
0.06(0.02–0.17)
P < 0.001SR
0.13(0.07–0.27)
P < 0.001Secondary outcomes
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| HF hospitalization, AFvs SR | 2.99 (1.26–7.13) | P = 0.013 | |
| HF hospitalization or all-cause mortality | 0.33 (0.16–0.70) | P = 0.003 | |
| 0.10.31310Adjusted hazard ratio (log scale) |
| Outcome | Difference (mL) (95% CI) | P value | |
|---|---|---|---|
| LV end-diastolic volume | −49.21 (−69.10 to −29.32) | P < 0.001 | |
| −100−50050Difference, mL (linear scale) |
- HF hospitalization or all-cause mortality: interaction P = 0.17
- LV end-diastolic volume: interaction P = 0.21
Original publication
Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation. Europace. Published 9 July 2024. doi:10.
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