The question was addressed using data included into the Multicenter Longitudinal Observational Study (MILOS). This registry included, using a prospectively pre-defined registry protocol, 1305 consecutive patients undergoing CRT pacemaker (CRT-P) or CRT defibrillator (CRT-D) device implant between August 1st 1995 and August 1st 2004 from 2 centers in Italy and 2 in Germany (22).
Long-term survival data of the entire population have been published in the American Journal of Cardiology (Auricchio et al. Am J Cardiol 2007; 99: 232 -238). In the Clinical Seminar Session entitled "Cardiac resynchronisation therapy: what is the hot news?" of this ESC meeting results referring to the importance of AV node ablation in CRT patients will be reported.
The MILOS results show for the first time the importance of AVJ ablation on long-term survival in AF patients treated with CRT. In our large multi-center series the long-term overall survival of drug-refractory heart failure patients with permanent AF and left ventricular conduction delay treated with CRT was similar to that of SR patients. However, in HF patients with permanent AF, AVJ ablation in addition to CRT significantly improves long-term overall mortality, compared to CRT alone, primarily by reducing HF death. AVJ ablation appears to be of paramount relevance in order to ensure adequate CRT delivery and thus reducing mortality in patients with permanent AF.
The clinical implication of our findings are large and may lead to an expansion of currently available ESC guidelines, indicating that AF patients may benefit from CRT but that a very aggressive treatment strategy, including ablation of the AV junction, should be performed in order to maximize the clinical and survival benefit of these patients.
The European Society of Cardiology (ESC):
The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.
The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.org.
European Society of Cardiology, The European Heart House 2035 Route des Colles, B.P. 179 - Les Templiers, Sophia Antipolis F-06903 France
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