Junctional AV ablation in patients with atrial fibrillation undergoing cardiac resynchronization therapy (JAVA-CRT): results of a multicenter randomized clinical trial pilot program

Jonathan S. Steinberg, John Gorcsan, Alexander Mazur, Sandeep K. Jain, Mayer Rashtian, G. Stephen Greer, Ignatius Zarraga, Margot Vloka, Michele Murphy Cook, Tariq Salam, Stavros Mountantonakis, Hiroko Beck, Jonathan Silver, Mehmet Aktas, Charles Henrikson, Robert D. Schaller, Andrew E. Epstein, Scott McNitt, Susan Schleede, Derick PetersonIlan Goldenberg, Wojciech Zareba

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Introduction: Cardiac resynchronization therapy (CRT) improves outcomes in sinus rhythm, but the data in atrial fibrillation (AF) is limited. Atrio-ventricular junctional ablation (AVJA) has been proposed as a remedy. The objective was to test if AVJA results in LV end-systolic volume (ESV) reduction ≥ 15% from baseline to 6 months. Methods: The trial was a prospective multicenter randomized trial in 26 patients with permanent AF who were randomized 1:1 to CRT-D with or without AVJA. Results: LVESV improved similarly by at least 15% in 5/10 (50%) in the CRT-D-only arm and in 6/12 (50%) in the AVJA + CRT-D arm (OR = 1.00 [0.14, 7.21], p = 1.00). In the CRT-D-only arm, the median 6-month improvement in LVEF was 9.2%, not different from the AVJA + CRT-D arm, 8.2%. When both groups were combined, a significant increase in LVEF was observed (25.4% at baseline vs 36.2% at 6 months, p = 0.002). NYHA class from baseline to 6 months for all patients combined improved 1 class in 15 of 24 (62.5%), whereas 9 remained in the same class and 0 degraded to a worse class. Conclusion: In patients with permanent AF, reduced LVEF, and broad QRS who were eligible for CRT, there was insufficient evidence that AVJA improved echocardiographic or clinical outcomes; the results should be interpreted in light of a smaller than planned sample size. CRT, however, seemed to be effective in the combined study cohort overall, suggesting that CRT can be reasonably deployed in patients with AF. Trial registration: ClinicalTrials.gov Identifier: NCT02946853.

    Original languageEnglish (US)
    Pages (from-to)519-530
    Number of pages12
    JournalJournal of Interventional Cardiac Electrophysiology
    Volume64
    Issue number2
    DOIs
    StatePublished - Aug 2022

    Keywords

    • AV junctional ablation
    • Atrial fibrillation
    • Biventricular pacing
    • Cardiac resynchronization therapy
    • Cardiomyopathy
    • Heart failure

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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