# AV-junctieablatie plus CRT bij permanent AF met smal QRS: APAF-CRT mortaliteitsanalyse

*geplaatst 2021-12-07 · Atriumfibrilleren · European heart journal · doi 10.1093/eurheartj/ehab569 · https://hartvaat.nl/2021/12/07/av-junctieablatie-plus-crt-bij-permanent-af-met-smal-qrs-apaf-crt-mortaliteitsan/*

APAF-CRT mortaliteitsanalyse van AV-junctieablatie plus CRT bij permanent AF met smal QRS. Bevestigt mortaliteitsreductie.

## English: AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehab569. Bijgewerkt 2026-07-03T13:28:40Z. 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.