Cardiac Resynchronization Therapy in Patients with Permanent Atrial Fibrillation: Results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT)

Circheartfailure.ahajournals.org: August 14, 2012

Cardiac resynchronization (CRT) prolongs survival in patients with systolic heart failure and QRS prolongation. However; most trials excluded patients with permanent atrial fibrillation (AF).

Methods and Results—The RAFT trial randomized patients to an implantable defibrillator (ICD) or ICD + CRT; stratified by the presence of permanent AF. Patients with permanent AF 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 vs. 70.4 ± 7.7 years), left ventricular ejection fraction (22.9 ± 5.3% vs. 22.3 ± 5.1%) and QRS duration (151.0 ± 23.6 vs. 153.4 ± 24.7 msec). There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD vs. ICD (HR=0.96; 95% CI: 0.65-1.41, p=0.82). Cardiovascular death was similar between treatment arms (HR=0.97; 95% CI: 0.55-1.71, p=0.91); however, there was a trend for fewer heart failure hospitalizations with CRT-ICD (HR=0.58; 95% CI: 0.38-1.01, p=0.052).  Read more