From the Guidelines
Yes, CRT-D (Cardiac Resynchronization Therapy-Defibrillator) can be used in patients with Atrial Fibrillation (AF) under certain conditions.
Key Conditions for CRT-D Use in AF
- The patient requires ventricular pacing or otherwise meets CRT criteria
- Atrioventricular nodal ablation or pharmacological rate control will allow near 100% ventricular pacing with CRT, as stated in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1 ### Rationale The use of CRT-D in AF is supported by guidelines that emphasize the importance of ensuring near 100% ventricular pacing to maximize clinical benefit and improve prognosis, as noted in the 2010 focused update of ESC guidelines on device therapy in heart failure 2, 3.
Important Considerations
- Patients with AF and LVEF ≤35% may satisfy the criteria for ICD implantation, and the presence of QRS prolongation would favor implantation of a CRT-D, as mentioned in the 2010 focused update of ESC guidelines on device therapy in heart failure 2.
- Essentially complete ventricular capture is mandatory to maximize clinical benefit and improve the prognosis of patients with permanent AF, which often requires creation of complete heart block by ablation of the AV junction given the frequently inadequate efficacy of pharmacological rate control, as discussed in the 2010 focused update of ESC guidelines on device therapy in heart failure 2.
From the Research
Use of CRT-D in AF Patients
- CRT-D (Cardiac Resynchronization Therapy-Defibrillator) is used in patients with atrial fibrillation (AF) as evidenced by studies 4, 5, 6, 7, 8.
- The benefits of CRT-D in AF patients include improved heart failure outcomes and reduced risk of adverse events 5.
- However, the efficacy of CRT-D in AF patients may be influenced by factors such as the presence of permanent AF, suboptimal CRT, and the type of device used 4, 6.
Clinical Importance of New-Onset AF
- New-onset AF after CRT-D implantation is associated with less left ventricular reverse remodeling and more adverse events 6.
- Patients who develop new-onset AF after CRT-D implantation may require closer monitoring and adjustment of their treatment plan 6.
Device Configuration and Programming
- The use of a standard CRT-D device with a modified lead configuration, such as dual-site right ventricular and left ventricular pacing, may be beneficial in AF patients 8.
- New device programming algorithms may be necessary to make patient-customized programming in this lead configuration more flexible and clinically useful 8.