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- Title
Junctional AV ablation in patients with atrial fibrillation undergoing cardiac resynchronization therapy (JAVA-CRT): results of a multicenter randomized clinical trial pilot program.
- Authors
Steinberg, Jonathan S.; Gorcsan, John; Mazur, Alexander; Jain, Sandeep K.; Rashtian, Mayer; Greer, G. Stephen; Zarraga, Ignatius; Vloka, Margot; Cook, Michele Murphy; Salam, Tariq; Mountantonakis, Stavros; Beck, Hiroko; Silver, Jonathan; Aktas, Mehmet; Henrikson, Charles; Schaller, Robert D.; Epstein, Andrew E.; McNitt, Scott; Schleede, Susan; Peterson, Derick
- Abstract
Introduction: Cardiac resynchronization therapy (CRT) improves outcomes in sinus rhythm, but the data in atrial fibrillation (AF) is limited. Atrio-ventricular junctional ablation (AVJA) has been proposed as a remedy. The objective was to test if AVJA results in LV end-systolic volume (ESV) reduction ≥ 15% from baseline to 6 months. Methods: The trial was a prospective multicenter randomized trial in 26 patients with permanent AF who were randomized 1:1 to CRT-D with or without AVJA. Results: LVESV improved similarly by at least 15% in 5/10 (50%) in the CRT-D-only arm and in 6/12 (50%) in the AVJA + CRT-D arm (OR = 1.00 [0.14, 7.21], p = 1.00). In the CRT-D-only arm, the median 6-month improvement in LVEF was 9.2%, not different from the AVJA + CRT-D arm, 8.2%. When both groups were combined, a significant increase in LVEF was observed (25.4% at baseline vs 36.2% at 6 months, p = 0.002). NYHA class from baseline to 6 months for all patients combined improved 1 class in 15 of 24 (62.5%), whereas 9 remained in the same class and 0 degraded to a worse class. Conclusion: In patients with permanent AF, reduced LVEF, and broad QRS who were eligible for CRT, there was insufficient evidence that AVJA improved echocardiographic or clinical outcomes; the results should be interpreted in light of a smaller than planned sample size. CRT, however, seemed to be effective in the combined study cohort overall, suggesting that CRT can be reasonably deployed in patients with AF. Trial registration: ClinicalTrials.gov Identifier: NCT02946853.
- Publication
Journal of Interventional Cardiac Electrophysiology, 2022, Vol 64, Issue 2, p519
- ISSN
1383-875X
- Publication type
Article
- DOI
10.1007/s10840-021-01116-6