Development of Heart Failure From Transient Atrial Fibrillation Attacks in Responders to Cardiac Resynchronization Therapy

Ikutaro Nakajima, Takashi Noda, Hideaki Kanzaski, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Hideo Okamura, Satoshi Nagase, Takeshi Aiba, Shiro Kamakura, Teruo Noguchi, Satoshi Yasuda, Yoshihiro J. Akashi, Kengo F. Kusano

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objectives: This study aimed to clarify the clinical impact of transient atrial fibrillation (AF) attacks themselves and the efficacy of cardiac resynchronization therapy (CRT) in patients with intermittent AF. Background: The benefit of CRT in patients with intermittent AF, especially the effect of the AF attacks themselves, remains unclear. Methods: Among our cohort of 269 consecutive CRT patients, we compared the percent of biventricular pacing (BIVP%) and other clinical characteristics between patients with intermittent AF and those with sinus rhythm (SR). Results: During a median follow-up of 942 days (interquartile range: 379 to 1,464 days) a total of 22 patients, including 59% of CRT responders, developed heart failure (HF) due to a transient AF attack itself, and that accounted for 21% of all HF events. The BIVP% during the AF attacks was significantly lower than that during SR (p < 0.05). When compared to the SR groups, patients with intermittent AF had a significantly higher risk of developing HF or death (hazard ratio: 2.2; 95% confidence interval: 1.3 to 3.8). However, the patients who received a BIVP% of ≥90% during AF attacks were comparable to those with SR (hazard ratio: 1.2; 95% confidence interval: 0.4 to 3.0). Conclusions: A substantial number of patients developed HF due to transient AF attacks themselves even in the CRT responders, and the reason was mainly due to the loss of the BIVP%.

Original languageEnglish
Pages (from-to)1227-1234
Number of pages8
JournalJACC: Clinical Electrophysiology
Issue number9
Publication statusPublished - 2018 Sept


  • atrial fibrillation
  • biventricular pacing rate
  • cardiac resynchronization therapy
  • clinical outcome
  • heart failure


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