Impact of non-paroxysmal atrial fibrillation on clinical and echocardiographic outcomes in cardiac resynchronization therapy responders in the late postoperative period (single-center retrospective observational study)

Introduction. Atrial fibrillation (AF) is a common and complex problem in patients with heart failure (HF). At the same time, AF and HF form a synergistic interaction. Cardiac resynchronization therapy (CRT) is an effective method of treating certain groups of patients with HF. In view of this fact, the negative dynamics of echocardiographic parameters in patients with effective CRT and nonparoxysmal AF is of interest for study.

Aim: To assess impact of non-paroxysmal AF on clinical and echocardiographic parameters in CRT responders at the late postoperative period.

Material and Methods. A single-center retrospective observational study was performed on 608 patients who underwent primary implantation of the CRT (-R / -D) between 2009 and 2022. The response to CRT was assessed at the time of the best dynamics of the parameters. 139 patients were selected. All patients with non-paroxysmal AF underwent radiofrequency ablation (RFA) of the atrioventricular node. Two groups of patients were formed based on this criterion. The primary endpoint was all-cause mortality in the long-term follow-up period.

Results. Descriptive statistics did not reveal a significant intergroup difference in demographic and basic clinical characteristics (p > 0.05), with the exception of a higher incidence of TIA/He also has a lower functional status in the group with AF. The results of echocardiographic data in the preand postoperative periods differed in most linear and volumetric parameters, with the exception of finite diastolic volume (CDV) and LVEF. In the sinus rhythm group, there was a statistically significant decrease in the incidence of severe valvular insufficiency, as well as significantly lower atrial volume and size of the right heart (p < 0.05). Postoperative analysis revealed positive dynamics of most parameters in both groups, however, there was no significant dynamics in the size of the pancreas and the TP gradient. In the long-term period, intergroup differences in LVEF, CDOs, and MR degree did not reach statistical significance, however, patients after RF AB connection had large right heart chambers. A single-factor analysis revealed statistically significant associations of overall mortality with art. (OR = 6.0; 95% CI 1.1–32.5), TR 3 art. (OR = 8.7; 95% CI 1.3–57.0) and MR 3 art. (OR = 9.6; 95% CI 2.9–31.7). According to the results of multifactorial regression analysis, the presence of severe MR in the preoperative period was associated with an increased chance of mortality (OR = 7.2; 95% CI 1.7 – 30.1). The overall mortality rate was 19.4% (n = 27), and there was no intergroup difference in long-term survival (p = 0.202).

Conclusion. Linear and volumetric parameters of the right heart chambers in CRT responders with nonparoxysmal AF were higher than those in patients with sinus rhythm. This group was more likely to have significant regurgitation of both AV valves, which persisted into the long-term follow-up. The association between AF and long-term all-cause mortality did not reach statistical significance.

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