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Atrial fibrillation and cardiac resynchronization therapy

Gasparini, Maurizio; Galimberti, Paola

Current Opinion in Cardiology: January 2018 - Volume 33 - Issue 1 - p 1–6
doi: 10.1097/HCO.0000000000000472
ARRHYTHMIAS: Edited by David Birnie

Purpose of review Atrial fibrillation and heart failure are commonly encountered in current clinical practice. This review aims to revisit the complex interaction of these two common situations and the best treatment whenever both occurs, especially focusing on heart failure patients undergoing cardiac resynchronization therapy (CRT).

Recent findings It has been recently confirmed that in patients undergoing cardiac resynchronization therapy, 100% biventricular pacing percentage should be pursued. Large observational studies confirmed that atrioventricular junction ablation is very often the only way to gain 100% biventricular pacing in atrial fibrillation.

Summary On the basis of the recent observational extensive data, in patients presenting intermediate or elevated atrial tachycardia–atrial fibrillation burden, atrioventricular junction ablation may represent a fundamental tool to achieve full CRT delivery, thus, conferring marked improvements in global cardiac function, and by extension, in survival. Atrial fibrillation patients should not be excluded from CRT, provided that maximal biventricular pacing is warranted.

Electrophysiology and Pacing Unit, Humanitas Research Hospital, Rozzano, Milano, Italy

Correspondence to Maurizio Gasparini, MD, Chief, Electrophysiology and Pacing Unit, Humanitas Research Hospital, Rozzano, Milano, Italy. Tel: +39 0282244622; e-mail: maurizio.gasparini@humanitas.it

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