{"id":"1491061d217a","type":"article","url":"https://hartvaat.nl/2018/12/01/av-junctieablatie-plus-crt-bij-permanent-af-gerandomiseerde-trial/","title":"AV-junctieablatie plus CRT bij permanent AF: gerandomiseerde trial","title_en":"A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy555","source_url":"https://doi.org/10.1093/eurheartj/ehy555","authors":["Michele Brignole","Evgeny Pokushalov","Francesco Pentimalli","Pietro Palmisano","Enrico Chieffo","Eraldo Occhetta","Fabio Quartieri","Leonardo Calò","Andrea Ungar","Lluis Mont"],"significance":7,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial demonstrated that AV junction ablation combined with CRT is superior to pharmacological therapy in patients with permanent AF and heart failure, showing improvements in functional capacity and left ventricular function.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die AV-junctieablatie plus CRT vergeleek met medicamenteuze therapie bij patiënten met permanent AF en hartfalen.","abstract_original":"AIMS: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. METHODS AND RESULTS: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004). CONCLUSION: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS. CLINICALTRIALS.GOV IDENTIFIER: NCT02137187 (May 2018, date last accessed)."}