Is there a role for bi-atrial pacing resynchronisation therapy in the management of drug-refractory atrial fibrillation in patients unsuitable for left atrial ablation?

Background: This retrospective cohort study evaluated whether long term outcome of atrial resynchronisation therapy using bi-atrial pacing (BiaP) to treat atrial fbrillation (AF) was effective in patients deemed unft for left atrial (LA) ablation procedures. Methods and Results: The patient population comprised 2 groups: those deemed suitable for left LA ablation (n=14) and those who were not (n=17). Both groups underwent BiaP and outcomes were evaluated by comparing symptoms, AF duration, admissions and antiarrhythmic drugs (AAD) for an equal period of time pre and post implantation. Median follow-up was 24 months (range 8-66 months) for the unsuitable group and 31 months (range 7-84 months) for the suitable group. Effcacy in reduction of both AF and symptoms was similar (P=0.44) in both groups (unsuitable group: 13/17; suitable group: 8/14). There was signifcant improvement in median AF episodes/week pre and post BiaP in both groups (unsuitable group AF reduction: 5 days/week, P=0.001; suitable group AF reduction: 4.9 days/week, P=0.03); the improvement was similar in both groups (P=0.33). There was a signifcant reduction in the median number of admissions for AF in both groups (unsuitable group: P=0.003; suitable group: P=0.01) and this reduction was also similar (P=0.70). The median number of AAD was also reduced to a similar degree (P=0.83) in both groups (suitable group: P=0.004; unsuitable group: P=0.001). Conclusions: Atrial resynchronisation therapy is effective in the long term management of drug-resistant AF in patients unsuitable for LA ablation, leading to signifcant reductions in symptoms, AF duration, admissions and AAD.