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Comparison of survival for cardiac resynchronization therapy in atrial fibrillation patients with or without atrio-ventricular junction ablation and patients in sinus rhythm: a systematic review and network meta-analysis

  • Yangjing Xue
  • Jinsheng Wang
  • Jiaoni Wang
  • Saroj Thapa
  • Kaiyu Huang
  • Yangpei Peng
  • Lu Qian
  • Jiwu LiEmail author
  • Kangting JiEmail author
Article

Abstract

Cardiac resynchronization therapy (CRT) has been established to improve prognosis for patients with heart failure and SR. Whether the benefit observed with CRT on survival was similar in AF patients receiving atrio-ventricular junction ablation (AVJA) or not and patients in SR remains uncertain. The primary purpose of this study was to comprehensively evaluate the impact of CRT on the outcome of survival in atrial fibrillation (AF) patients with or without AVJA and patients in sinus rhythm (SR). Medline, Embase, and the Cochrane Library were searched for inception through June 31, 2018. Two reviewers independently evaluated and extracted data from 4 studies, including a total of 7896 CRT recipients, composed of 554 AF with AVJA (CRT+AF+AVJA), 1071 AF without AVJA (CRT+AF-AVJA), and 6244 SR (CRT+SR). The benefit on survival was comparable between CRT+AF+AVJA and CRT+SR (HR = 1.00; 95% CI, 0.73–1.40). CRT+AF+AVJA and CRT+SR both were associated with significantly higher survival compared with CRT+AF-AVJA, with hazard ratio of 0.64 (95% CI, 0.46–0.91) and 0.63 (95% CI, 0.53–0.75), respectively. The survival benefit was similar for patients with CRT+AF+AVJA and CRT+SR, while it was 36–37% high as compared to CRT+AF-AVJA. Whether aggressive intervention with AVJA in AF should be routinely combined with CRT despite rate-slowing drug treatment is helpful deserves further studies.

Keywords

Atrial fibrillation Cardiac resynchronization therapy Atrio-ventricular junction ablation Heart failure Survival 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10741_2018_9761_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yangjing Xue
    • 1
  • Jinsheng Wang
    • 1
  • Jiaoni Wang
    • 1
  • Saroj Thapa
    • 1
  • Kaiyu Huang
    • 1
  • Yangpei Peng
    • 1
  • Lu Qian
    • 1
  • Jiwu Li
    • 1
    Email author
  • Kangting Ji
    • 1
    Email author
  1. 1.Department of Cardiology, the Second Affiliated Hospital and Yuying Children’s HospitalWenzhou Medical UniversityWenzhouChina

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