{"id":"03fc73711555","type":"article","url":"https://hartvaat.nl/2021/12/07/av-junctieablatie-plus-crt-bij-permanent-af-met-smal-qrs-apaf-crt-mortaliteitsan/","title":"AV-junctieablatie plus CRT bij permanent AF met smal QRS: APAF-CRT mortaliteitsanalyse","title_en":"AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab569","source_url":"https://doi.org/10.1093/eurheartj/ehab569","authors":["Michele Brignole","Francesco Pentimalli","Pietro Palmisano","Maurizio Landolina","Fabio Quartieri","Eraldo Occhetta","Leonardo Calò","Giuseppe Mascia","Lluis Mont","Kevin Vernooy","Vincent van Dijk","Cor Allaart","Laurent Fauchier","Maurizio Gasparini","Gianfranco Parati","Davide Soranna","Michiel Rienstra","Isabelle C Van Gelder"],"significance":8,"published":"2021-12-07","source_date":"2021-12-07","image":"","kennis":[],"congress":"","summary_en":"The APAF-CRT mortality analysis confirmed that AV junction ablation combined with cardiac resynchronization therapy significantly reduced all-cause mortality in patients with permanent atrial fibrillation, narrow QRS, and heart failure. The result established this strategy as a life-saving intervention in drug-refractory AF with HF.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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":"APAF-CRT mortaliteitsanalyse van AV-junctieablatie plus CRT bij permanent AF met smal QRS. Bevestigt mortaliteitsreductie.","abstract_original":"AIMS: In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation + CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown. METHODS AND RESULTS: In this international, open-label, blinded outcome trial, we randomly assigned patients with severely symptomatic permanent AF >6 months, narrow QRS (≤110 ms) and at least one HF hospitalization in the previous year to Ablation + CRT or to pharmacological rate control. We hypothesized that Ablation + CRT is superior in reducing the primary endpoint of all-cause mortality. A total of 133 patients were randomized. The mean age was 73 ± 10 years, and 62 (47%) were females. The trial was stopped for efficacy at interim analysis after a median of 29 months of follow-up per patient. The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10-0.65; P = 0.004]. The estimated death rates at 2 years were 5% and 21%, respectively; at 4 years, 14% and 41%. The benefit of Ablation + CRT of all-cause mortality was similar in patients with ejection fraction (EF) ≤35% and in those with >35%. The secondary endpoint combining all-cause mortality or HF hospitalization was significantly lower in the Ablation + CRT arm [18 (29%) vs. 36 (51%); HR 0.40, 95% CI 0.22-0.73; P = 0.002]. CONCLUSIONS: Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT02137187."}