Effects Of Atrioventricular Nodal Ablation On Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy:A Systematic Review And Meta-analysis

Background : Cardiac resynchronization therapy(CRT)is an effective therapy in heart failure patients with sinus rhythm,but responding poorly to atrial fibrillation(AF).For those patients with permanent AF who underwent atrioventricular nodal(AVN)ablation can improve the efficacy of CRT is still controversial.Objective : Our objective was to evaluate mortality and clinical outcomes of AVN ablation in heart failure patients with permanent AF receiving CRT.Results:12 studies with 2487 patients were included.Among patients with permanent AF and heart failure receiving CRT,comparing to medical therapy,the AVN ablation had a significant effect on reducing all-cause mortality(n=2023,RR:0.82;95%CI 0.71—0.98,P=0.025)and cardiac mortality(n=1789,RR:0.75,95%CI 0.61—0.93,p=0.009),improve LVEF(n=1885,WMD:3.26;95%C 2.30—4.22,p<0.001)and NYHA class,but had no significant improvement in LVDD?6MWD and the nonresponse of CRT.Subgroup analysis suggested that for those with Ischemic >40%,adjunctive AVN ablation was associated with reduce all-cause mortality(n=452,RR:0.43;95%CI 0.26—0.69,p=0.001,I2=0)and cardiac mortality.Furthermore,for those BIV < 90%,atrioventricular junction ablation can significantly reduce cardiac mortality and the nonresponse of CRT compared with those drug therapy.Conclusion : In patients with permanent AF undergoing CRT,compared with the drug control ventricular rate well patients,the ventricular rate uncontrolled patients who received AVN ablation had the same effect on reducing all-cause mortality,Which may even better than it.For those BIV < 90% or Ischemic > 40%,atrioventricular junction ablation had a better effect on treatment.While for those BIV>90%,AVN ablation may not be necessary.