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The following is a summary of “Rhythm and rate control strategies in patients with long-standing persistent atrial fibrillation treated with cardiac resynchronization: the results of the randomized Pilot-CRAfT study,” published in the October 2024 issue of Cardiology by Ciszewski et al.        

Atrial fibrillation (AF) is prevalent among patients receiving cardiac resynchronization therapy (CRT) and indicates a poor response to CRT, largely due to decreased effective biventricular paced beats (BiVp).  

Researchers conducted a prospective study comparing the efficacy of rhythm control and rate control strategies in patients with long-standing persistent AF.  

They performed a randomized trial involving recipients of CRT with persistent AF and low BiVp%. The rhythm control group underwent external electrical cardioversion (EC), while the rate control group received atrioventricular node ablation as needed. The primary endpoint assessed was the 12-month BiVp% (NCT).  

The results showed 43 patients, with a mean age of 68.4 years (SD: ± 8.3) and a mean BiVp% of 82.4% (± 9.7), AF duration averaged 25 months (± 19), while mean left ventricular ejection fraction (LVEF), left atrial area, and maximal oxygen uptake (VO2max) was 30% (± 8%), 33 cm² (± 7), and 14 mL/(kg^* min) (± 5), respectively. The external EC success rate was 58%, and 38% remained in sinus rhythm (SR) after 12 months, BiVp% increased similarly in both groups, reaching 99% [95% CI 97.3–99.8] in the rhythm control group and 98% [94.0–99.0] in the rate control group (P=0.14). Only the rhythm control group experienced a significant increase in LVEF (ΔLVEF 4.1 (± 7.3), P=0.018), primarily among those who maintained SR. No differences were observed in VO2max, QoL, or safety endpoints.  

They concluded that while both strategies achieved similar BiVp%, only restoring SR led to increased LVEF in patients with CRT with long-standing AF.  

Source: link.springer.com/article/10.1007/s00392-024-02541-z