Document Detail

Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT).
MedLine Citation:
PMID:  22896584     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiac resynchronization (CRT) prolongs survival in patients with systolic heart failure and QRS prolongation. However, most trials excluded patients with permanent atrial fibrillation.
METHODS AND RESULTS: The Resynchronization for Ambulatory Heart Failure Trial (RAFT) randomized patients to an implantable cardioverter defibrillator (ICD) or ICD+CRT, stratified by the presence of permanent atrial fibrillation. Patients with permanent atrial fibrillation were randomized to CRT-ICD (n=114) or ICD (n=115). Patients receiving a CRT-ICD were similar to those receiving an ICD: age (71.6±7.3 versus 70.4±7.7 years), left ventricular ejection fraction (22.9±5.3% versus 22.3±5.1%), and QRS duration (151.0±23.6 versus 153.4±24.7 ms). There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD versus ICD (hazard ratio, 0.96; 95% CI, 0.65-1.41; P=0.82). Cardiovascular death was similar between treatment arms (hazard ratio, 0.97; 95% CI, 0.55-1.71; P=0.91); however, there was a trend for fewer heart failure hospitalizations with CRT-ICD (hazard ratio, 0.58; 95% CI, 0.38-1.01; P=0.052). The change in 6-minute hall walk duration between baseline and 12 months was not different between treatment arms (CRT-ICD: 19±84 m versus ICD: 16±76 m; P=0.88). Patients treated with CRT-ICD showed a trend for a greater improvement in Minnesota Living with Heart Failure score between baseline and 6 months (CRT-ICD: 41±21 to 31±21; ICD: 33±20 to 28±20; P=0.057).
CONCLUSIONS: Patients with permanent atrial fibrillation who are otherwise CRT candidates appear to gain minimal benefit from CRT-ICD compared with a standard ICD.
Jeff S Healey; Stefan H Hohnloser; Derek V Exner; David H Birnie; Ratika Parkash; Stuart J Connolly; Andrew D Krahn; Chris S Simpson; Bernard Thibault; Magdy Basta; Francois Philippon; Paul Dorian; Girish M Nair; Soori Sivakumaran; Elizabeth Yetisir; George A Wells; Anthony S L Tang;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-08-14
Journal Detail:
Title:  Circulation. Heart failure     Volume:  5     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-19     Completed Date:  2012-12-03     Revised Date:  2013-04-26    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  566-70     Citation Subset:  IM    
Population Health Research Institute, Hamilton, Ontario, Canada.
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MeSH Terms
Action Potentials
Atrial Fibrillation / complications*,  diagnosis,  mortality,  physiopathology
Cardiac Resynchronization Therapy* / adverse effects,  mortality
Cardiac Resynchronization Therapy Devices
Defibrillators, Implantable
Electric Countershock* / adverse effects,  instrumentation,  mortality
Exercise Test
Heart Failure / complications,  diagnosis,  mortality,  physiopathology,  therapy*
Kaplan-Meier Estimate
Middle Aged
Proportional Hazards Models
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Comment In:
Circ Heart Fail. 2013 Mar 1;6(2):e22   [PMID:  23513051 ]
Circ Heart Fail. 2012 Sep 1;5(5):547-9   [PMID:  22991403 ]

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