A Meta-Analysis of CRT in patients with heart failure and the development of atrial fibrillation.

KingdomThe prevalence of atrial fibrillation (AF) in patients with chronic heartfailure is substantial and may adversely affect prognosis. Cardiac resynchronisationtherapy (CRT) is increasingly used in the management ofsevere left ventricular dysfunction and cardiac dyssynchrony, and can improveleft ventricular function and remodelling. Recent data suggest thatCRT is also associated with reverse atrial remodelling, and so it has beenhypothesised that CRT may have a favourable effect on the developmentof AF in patients with heart failure. A number of small trials have showninconsistent results regarding this issue. We have therefore performedthis meta-analysis to investigate the role of CRT on the development ofAF in patients with heart failure.Using the key terms atrial fibrillation and heart failure via pubmed,OVID medline, embase and Google scholar, 6 trials investigating the roleof CRT on the development of AF were identified involving 1544 patientsand a meta-analysis of the data was performed. Publication level data wasused and the development of AF was documented from 6 months to 3years in these trials. AF developed in 167 of the 810 patients treated withCRT (20.6%) and in 151 of the 734 control patients (20.5%) over thistime period. Meta-analysis of these 6 trials did not reveal any significanteffect from CRT treatment on the development of AF, Odds ratio 0.84,95% CI 0.64-1.09, P>0.05 (Figure 1).