Document Detail

Cardiac resynchronization in patients with atrial fibrillation: a meta-analysis of prospective cohort studies.
MedLine Citation:
PMID:  18926327     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study is a meta-analysis of prospective cohort studies comparing the impact of cardiac resynchronization therapy (CRT) for patients in atrial fibrillation (AF) and sinus rhythm (SR). BACKGROUND: Although close to one-third of advanced heart failure patients exhibit AF, the impact of CRT in this group remains unclear. METHODS: Prospective cohort studies comparing patients in normal SR and chronic AF treated with CRT were included. All studies reported death, New York Heart Association functional class, ejection fraction, 6-min walk test, and the Minnesota score or its equivalent as outcomes. Data sources included Ovid MEDLINE In-Process & Other Non-Indexed Citations, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects, and the American College of Physicians Journal Club. RESULTS: Of 2,487 reports identified, 5 studies following a total of 1,164 patients were included. Both AF and SR patients benefited significantly from CRT. Mortality was not significantly different at 1 year (relative risk ratio: 1.57, 95% confidence interval [CI]: 0.87 to 2.81). The New York Heart Association functional class improved similarly for both groups (-0.90 for SR patients, -0.84 for AF patients). SR patients showed greater relative improvement in the 6-min walk test (11.6 m greater, 95% CI: 10.4 to 12.8 m) and the Minnesota score (3.9 points less, 95% CI: 3.4 to 4.5 points) than AF patients. AF patients, however, achieved a small but statistically significant greater change in ejection fraction (0.39% greater change in ejection fraction, 95% CI: 0.22% to 0.55%). CONCLUSIONS: Patients in AF show significant improvement after CRT, with similar or improved ejection fraction as SR patients, but smaller benefits in regard to functional outcomes.
Gaurav A Upadhyay; Niteesh K Choudhry; Angelo Auricchio; Jeremy Ruskin; Jagmeet P Singh
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  52     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-17     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1239-46     Citation Subset:  AIM; IM    
Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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MeSH Terms
Atrial Fibrillation / physiopathology,  therapy*
Cardiac Pacing, Artificial
Cohort Studies
Prospective Studies
Comment In:
J Am Coll Cardiol. 2008 Oct 7;52(15):1247-9   [PMID:  18926328 ]

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