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Canadian Journal of Cardiology

Development of Atrial Fibrillation in Recipients of Cardiac Resynchronization Therapy: The Role of Atrial Reverse Remodelling

Published:January 16, 2012DOI:https://doi.org/10.1016/j.cjca.2011.11.001
      To the Editor:
      We congratulate Wilton et al. for their interesting report in a recent issue of the Canadian Journal of Cardiology, regarding the role of rate-controlled persistent atrial fibrillation (AF) on the clinical outcome and ventricular remodelling in patients receiving cardiac resynchronization therapy (CRT).
      • Wilton S.B.
      • Kavanagh K.M.
      • Aggarwal S.G.
      • et al.
      Association of rate-controlled persistent atrial fibrillation with clinical outcome and ventricular remodelling in recipients of cardiac resynchronization therapy.
      In this post hoc analysis there are follow-up data (2.8 ± 1.4 years) for 86 patients (19 with and 67 without persistent AF). Using a composite of objective symptomatic improvement and left ventricular (LV) reverse remodelling, the authors find that subjects with and without AF have a similar likelihood of responding to CRT in the first year of treatment. However, those in the AF group have significantly less improvement in LV end-systolic volume, with a doubled risk of death or cardiac transplantation during long-term follow-up.
      We have several comments concerning the relationship between CRT response and the incidence of new-onset AF. Prior reports have yielded controversial results regarding the effect of CRT on the incidence of AF.
      • Brenyo A.
      • Link M.S.
      • Barsheshet A.
      • et al.
      Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).
      • D'Ascia S.L.
      • D'Ascia C.
      • Marino V.
      • et al.
      Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non-ischaemic dilated cardiomyopathy.
      In the study by Wilton et al., 18% of patients in the non-AF group developed AF during follow-up after CRT, but unfortunately there is no information about the role of CRT response. It would be interesting to know how many patients that developed new-onset AF were “CRT responders” and how many were “nonresponders.” Although LV function was evaluated by multiple gated acquisition we would like to know if there are also data (simple echocardiography could be enough) regarding atrial dimension and function,
      • Brenyo A.
      • Link M.S.
      • Barsheshet A.
      • et al.
      Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).
      • D'Ascia S.L.
      • D'Ascia C.
      • Marino V.
      • et al.
      Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non-ischaemic dilated cardiomyopathy.
      in order to compare atrial reverse remodelling in CRT responders and nonresponders.
      • D'Ascia S.L.
      • D'Ascia C.
      • Marino V.
      • et al.
      Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non-ischaemic dilated cardiomyopathy.
      Moreover, if possible the authors might provide an analysis regarding the role of the etiology of cardiomyopathy (ischemic vs nonischemic) in the development of AF.
      • D'Ascia S.L.
      • D'Ascia C.
      • Marino V.
      • et al.
      Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non-ischaemic dilated cardiomyopathy.
      • McLeod C.J.
      • Shen W.K.
      • Rea R.F.
      • et al.
      Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy.

      Disclosures

      The authors have no conflicts of interest to disclose.

      References

        • Wilton S.B.
        • Kavanagh K.M.
        • Aggarwal S.G.
        • et al.
        Association of rate-controlled persistent atrial fibrillation with clinical outcome and ventricular remodelling in recipients of cardiac resynchronization therapy.
        Can J Cardiol. 2011; 27: 787-793
        • Brenyo A.
        • Link M.S.
        • Barsheshet A.
        • et al.
        Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).
        J Am Coll Cardiol. 2011; 58: 1682-1689
        • D'Ascia S.L.
        • D'Ascia C.
        • Marino V.
        • et al.
        Cardiac resynchronisation therapy response predicts occurrence of atrial fibrillation in non-ischaemic dilated cardiomyopathy.
        Int J Clin Pract. 2011; 65: 1149-1155
        • McLeod C.J.
        • Shen W.K.
        • Rea R.F.
        • et al.
        Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy.
        Heart Rhythm. 2011; 8: 377-382

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