human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Atrioventricular nodal radiofrequency ablation ( AVNA ) with permanent ventricular pacing can be used to control rate in patients with atrial fibrillation ( AF ) . However , long-term outcomes after AVNA are uncertain , especially in light of irreversible pacemaker dependence . Methods and Results —We examined 9122 consecutive patients with AF . The outcomes in 453 patients with AVNA ( 26 % of whom underwent an implantable cardiac defibrillator implant and 37 % underwent cardiac resynchronization therapy implant ) were compared with AF patients without AVNA after propensity score 1:1 matching . During follow-up in the propensity-matched cohort ( 2.41±3.23 years , median 1.23 , quartiles 0.33–3.12 ) , 100 patients died ( yearly rate of death 6.6 % ) . Mode of death was available in 86 % of patients , which was cardiovascular in 67 % of the patients ( related to heart failure in 38 % , sudden death in 5 % , and other cardiovascular reason in 24 % ) and noncardiovascular in 33 % . AVNA in patients with AF was associated with a lower risk of mortality ( odds ratio 0.47 , 95 % confidence interval , 0.29–0.77 ; P=0.003 ) , a lower risk of cardiovascular mortality ( odds ratio = 0.41 , 95 % confidence interval 0.23–0.73 ; P=0.003 ) , and nonsignificant lower risk of stroke and thromboembolic events ( odds ratio = 0.61 , 95 % confidence interval 0.36–1.06 ; P=0.08 ) . Conclusions —In sick AF patients with multiple comorbidities  , AVNA with permanent ventricular pacing for rate control seems safe during follow-up and may be associated with lower mortality Background —Cardiac resynchronization ( CRT ) prolongs survival in patients with systolic heart failure and QRS prolongation . However , most trials excluded patients with permanent atrial fibrillation . Methods and Results —The Resynchronization for Ambulatory Heart Failure Trial ( RAFT ) r and omized patients to an implantable cardioverter defibrillator ( ICD ) or ICD+CRT , stratified by the presence of permanent atrial fibrillation . Patients with permanent atrial fibrillation were r and omized to CRT-ICD ( n=114 ) or ICD ( n=115 ) . Patients receiving a CRT-ICD were similar to those receiving an ICD  : age ( 71.6±7.3 versus 70.4±7.7 years ) , left ventricular ejection fraction ( 22.9±5.3 % versus 22.3±5.1 % ) , and QRS duration ( 151.0±23.6 versus 153.4±24.7 ms ) . There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD versus ICD ( hazard ratio , 0.96 ; 95 % CI , 0.65–1.41 ; P=0.82 ) . Cardiovascular death was similar between treatment arms ( hazard ratio , 0.97 ; 95 % CI , 0.55–1.71 ; P=0.91 ) ; however , there was a trend for fewer heart failure hospitalizations with CRT-ICD ( hazard ratio , 0.58 ; 95 % CI , 0.38–1.01 ; P=0.052 ) . The change in 6-minute hall walk duration between baseline and 12 months was not different between treatment arms ( CRT-ICD : 19±84 m versus ICD : 16±76 m ; P=0.88 ) . Patients treated with CRT-ICD showed a trend for a greater improvement in Minnesota Living with Heart Failure score between baseline and 6 months ( CRT-ICD : 41±21 to 31±21 ; ICD : 33±20 to 28±20 ; P=0.057 ) . Conclusions — Patients with permanent atrial fibrillation who are otherwise CRT c and i date s appear to gain minimal benefit from CRT-ICD compared with a st and ard ICD . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00251251 BACKGROUND Controlled clinical trial data are lacking for cardiac resynchronization therapy ( CRT ) outcomes in patients with advanced heart failure ( HF ) from reduced left ventricular ejection fraction ( HFrEF ) and intermittent atrial fibrillation or flutter ( IAF/AFL ) . OBJECTIVE The purpose of this study was to describe CRT outcomes in patients with IAF/AFL and advanced HF . METHODS HF outcomes in patients in the COMPANION ( Comparison of Medical Therapy , Pacing , and Defibrillation in Heart Failure ) trial with New York Heart Association class III or IV HFrEF , left ventricular ejection fraction ≤0.35 , sinus rhythm at r and omization , and no history of baseline arrhythmia were compared with those with a history of IAF/AFL . RESULTS In those with no history of baseline arrhythmia ( n = 887 ) , compared with optimal pharmacological therapy ( OPT ) with no CRT , the CRT + OPT arms exhibited a significant reduction in the end points of death or any hospitalization ( hazard ratio [ HR ] 0.73 [ 95 % Confidence Interval ( CI ) : 0.60 to 0.89 ] ; P = .002 ) and death or HF hospitalization ( HR 0.53 [ 95 % CI : 0.41 to 0.68 ] ; P < .001 ) . In contrast , in the IAF/AFL subgroup ( n = 293 ) , CRT did not result in improved outcomes compared with OPT ( death or any hospitalization : HR 1.16 [ 95 % CI : 0.83 to 1.63 ] ; P = .38 ; death or HF hospitalization : HR 0.97 [ 95 % CI : 0.64 to 1.46 ] ; P = .88 ) . The interaction between history of AF/AFL and CRT was statistically significant for both outcomes ( P < .05 ) . CONCLUSION In the COMPANION trial , patients with moderate to severe HFrEF and a history of IAF/AFL had no benefit from CRT OBJECTIVES The main objective of this study was to assess if the benefits of biventricular ( BiV ) pacing observed during the crossover phase were sustained over 12 months . BACKGROUND MUltisite STimulation In Cardiomyopathies ( MUSTIC ) is a r and omized controlled study intended to evaluate the effects of BiV pacing in patients with New York Heart Association ( NYHA ) class III heart failure and intraventricular conduction delay . METHODS Of 131 patients included , 42/67 in sinus rhythm ( SR ) and 33/64 in atrial fibrillation ( AF ) were followed up longitudinally at 9 and 12 months by 6-min walked distance , peak oxygen uptake ( peak VO(2 ) ) , quality of life by the Minnesota score , NYHA class , echocardiography , and left ventricular ejection fraction by radionuclide technique . RESULTS At 12 months , all SR and 88 % of AF patients were programmed to BiV pacing . Compared with baseline , the 6-min walked distance increased by 20 % ( SR ) ( p = 0.0001 ) and 17 % ( AF ) ( p = 0.004 ) ; the peak VO(2 ) by 11 % ( SR ) and 9 % ( AF ) ; quality of life improved by 36 % ( SR ) ( p = 0.0001 ) and 32 % ( AF ) ( p = 0.002 ) ; NYHA class improved by 25 % ( SR ) ( p = 0.0001 ) and 27 % ( AF ) ( p = 0.0001 ) . The ejection fraction improved by 5 % ( SR ) and 4 % ( AF ) . Mitral regurgitation decreased by 45 % ( SR ) and 50 % ( AF ) . CONCLUSIONS The clinical benefits of BiV pacing appeared to be significantly maintained over a 12-month follow-up period Background —Whether adding cardiac resynchronization therapy ( CRT-D ) to an implanted cardioverter – defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias ( AF/AT ) , or if postimplantation AF/AT modulate the benefits of CRT-D , remain unknown . Methods and Results —We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial ( RAFT ) participants without permanent AF , who were r and omized to CRT-D ( n=495 ) versus nonresynchronization defibrillator ( implanted cardioverter – defibrillator ; n=477 ) within the predefined stratum eligible for an atrial lead . Occurrence of postr and omization AF/AT was prospect ively assessed , and Cox models were used to test the independent association between the postr and omization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure . Over 41 ( ±19 ) months , postr and omization AF/AT occurred in 216 ( 45.3 % ) patients r and omized to implanted cardioverter – defibrillator and 249 ( 50.3 % ) r and omized to CRT-D. After adjusting for competing risk of death , r and omization to CRT-D increased risk of postr and omization AF/AT ( hazard ratio , 1.20 ; 95 % confidence interval , 1.00–1.42 ; P=0.045 ) . Postr and omization AF/AT , which remained paroxysmal in 69.5 % , did not reduce biventricular pacing percentage . In adjusted models , postr and omization AF/AT was not associated with the primary outcome ( hazard ratio , 1.04 ; 95 % confidence interval , 0.84–1.30 ) . However , AF/AT was associated with a borderline decreased risk of mortality ( hazard ratio , 0.75 ; 95 % confidence interval , 0.58–1.00 ) but increased risk of heart failure hospitalization ( hazard ratio , 1.43 ; 95 % confidence interval , 1.08–1.90 ) . Conclusions —In RAFT , nearly half of the patients developed postr and omization AF/AT , and those r and omized to CRT-D had borderline significant higher risk . Postr and omization AF/AT was associated with risk of heart failure hospitalization , but not with the primary composite outcome . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00251251 Background — Atrial fibrillation/flutter ( AF ) and heart failure often coexist ; however , the effect of cardiac resynchronization therapy ( CRT ) on the incidence of AF and on the outcome of patients with new-onset AF remains undefined . Methods and Results — In the CArdiac REsynchronisation in Heart Failure ( CARE-HF ) trial , 813 patients with moderate or severe heart failure were r and omly assigned to pharmacological therapy alone or with the addition of CRT . The incidence of AF was assessed by adverse event reporting and by ECGs during follow-up , and the impact of new-onset AF on the outcome and efficacy of CRT was evaluated . By the end of the study ( mean duration of follow-up 29.4 months ) , AF had been documented in 66 patients in the CRT group compared with 58 who received medical therapy only ( 16.1 % versus 14.4 % ; hazard ratio 1.05 ; 95 % confidence interval , 0.73 to 1.50 ; P=0.79 ) . There was no difference in the time until first onset of AF between groups . Mortality was higher in patients who developed AF , but AF was not a predictor in the multivariable model ( hazard ratio 1.17 ; 95 % confidence interval , 0.82 to 1.67 ; P=0.37 ) . In patients with new-onset AF , CRT significantly reduced the risk for all-cause mortality and all other predefined end points and improved ejection fraction and symptoms ( no interaction between AF and CRT ; all P>0.2 ) . Conclusions — Although CRT did not reduce the incidence of AF , CRT improved the outcome regardless of whether AF developed Objective : To compare the effects of cardiac resynchronisation therapy ( CRT ) in patients with heart failure ( HF ) in either atrial fibrillation ( AF ) or sinus rhythm ( SR ) . Design : Prospect i ve observational study . Patients : 295 consecutive patients with HF ( permanent AF in 66 , paroxysmal AF in 20 , SR in 209 ; New York Heart Association ( NYHA ) class III or IV ; left ventricular ejection fraction ( LVEF ) ⩽35 % , QRS ⩾120 ms ) . Interventions : All patients underwent CRT without atrioventricular junction ablation . Main outcome measures : The primary end point was the composite of cardiovascular death or unplanned hospitalisation for major cardiovascular events . Secondary end points included the composite of cardiovascular death or hospitalisation for worsening HF . Cardiovascular mortality , total mortality and changes in NYHA class , 6-minute walking distance , quality of life ( Minnesota Living with Heart Failure question naire ) and echocardiographic variables were 
    Output:
    
agent
Conclusion The results of our meta- analysis suggest that AF was associated with decreased CRT benefits in patients with HF .
CRT , however , benefits patients with AF with AVJ ablation
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Atrioventricular nodal radiofrequency ablation ( AVNA ) with permanent ventricular pacing can be used to control rate in patients with atrial fibrillation ( AF ) . However , long-term outcomes after AVNA are uncertain , especially in light of irreversible pacemaker dependence . Methods and Results —We examined 9122 consecutive patients with AF . The outcomes in 453 patients with AVNA ( 26 % of whom underwent an implantable cardiac defibrillator implant and 37 % underwent cardiac resynchronization therapy implant ) were compared with AF patients without AVNA after propensity score 1:1 matching . During follow-up in the propensity-matched cohort ( 2.41±3.23 years , median 1.23 , quartiles 0.33–3.12 ) , 100 patients died ( yearly rate of death 6.6 % ) . Mode of death was available in 86 % of patients , which was cardiovascular in 67 % of the patients ( related to heart failure in 38 % , sudden death in 5 % , and other cardiovascular reason in 24 % ) and noncardiovascular in 33 % . AVNA in patients with AF was associated with a lower risk of mortality ( odds ratio 0.47 , 95 % confidence interval , 0.29–0.77 ; P=0.003 ) , a lower risk of cardiovascular mortality ( odds ratio = 0.41 , 95 % confidence interval 0.23–0.73 ; P=0.003 ) , and nonsignificant lower risk of stroke and thromboembolic events ( odds ratio = 0.61 , 95 % confidence interval 0.36–1.06 ; P=0.08 ) . Conclusions —In sick AF patients with multiple comorbidities  , AVNA with permanent ventricular pacing for rate control seems safe during follow-up and may be associated with lower mortality Background —Cardiac resynchronization ( CRT ) prolongs survival in patients with systolic heart failure and QRS prolongation . However , most trials excluded patients with permanent atrial fibrillation . Methods and Results —The Resynchronization for Ambulatory Heart Failure Trial ( RAFT ) r and omized patients to an implantable cardioverter defibrillator ( ICD ) or ICD+CRT , stratified by the presence of permanent atrial fibrillation . Patients with permanent atrial fibrillation were r and omized to CRT-ICD ( n=114 ) or ICD ( n=115 ) . Patients receiving a CRT-ICD were similar to those receiving an ICD  : age ( 71.6±7.3 versus 70.4±7.7 years ) , left ventricular ejection fraction ( 22.9±5.3 % versus 22.3±5.1 % ) , and QRS duration ( 151.0±23.6 versus 153.4±24.7 ms ) . There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD versus ICD ( hazard ratio , 0.96 ; 95 % CI , 0.65–1.41 ; P=0.82 ) . Cardiovascular death was similar between treatment arms ( hazard ratio , 0.97 ; 95 % CI , 0.55–1.71 ; P=0.91 ) ; however , there was a trend for fewer heart failure hospitalizations with CRT-ICD ( hazard ratio , 0.58 ; 95 % CI , 0.38–1.01 ; P=0.052 ) . The change in 6-minute hall walk duration between baseline and 12 months was not different between treatment arms ( CRT-ICD : 19±84 m versus ICD : 16±76 m ; P=0.88 ) . Patients treated with CRT-ICD showed a trend for a greater improvement in Minnesota Living with Heart Failure score between baseline and 6 months ( CRT-ICD : 41±21 to 31±21 ; ICD : 33±20 to 28±20 ; P=0.057 ) . Conclusions — Patients with permanent atrial fibrillation who are otherwise CRT c and i date s appear to gain minimal benefit from CRT-ICD compared with a st and ard ICD . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00251251 BACKGROUND Controlled clinical trial data are lacking for cardiac resynchronization therapy ( CRT ) outcomes in patients with advanced heart failure ( HF ) from reduced left ventricular ejection fraction ( HFrEF ) and intermittent atrial fibrillation or flutter ( IAF/AFL ) . OBJECTIVE The purpose of this study was to describe CRT outcomes in patients with IAF/AFL and advanced HF . METHODS HF outcomes in patients in the COMPANION ( Comparison of Medical Therapy , Pacing , and Defibrillation in Heart Failure ) trial with New York Heart Association class III or IV HFrEF , left ventricular ejection fraction ≤0.35 , sinus rhythm at r and omization , and no history of baseline arrhythmia were compared with those with a history of IAF/AFL . RESULTS In those with no history of baseline arrhythmia ( n = 887 ) , compared with optimal pharmacological therapy ( OPT ) with no CRT , the CRT + OPT arms exhibited a significant reduction in the end points of death or any hospitalization ( hazard ratio [ HR ] 0.73 [ 95 % Confidence Interval ( CI ) : 0.60 to 0.89 ] ; P = .002 ) and death or HF hospitalization ( HR 0.53 [ 95 % CI : 0.41 to 0.68 ] ; P < .001 ) . In contrast , in the IAF/AFL subgroup ( n = 293 ) , CRT did not result in improved outcomes compared with OPT ( death or any hospitalization : HR 1.16 [ 95 % CI : 0.83 to 1.63 ] ; P = .38 ; death or HF hospitalization : HR 0.97 [ 95 % CI : 0.64 to 1.46 ] ; P = .88 ) . The interaction between history of AF/AFL and CRT was statistically significant for both outcomes ( P < .05 ) . CONCLUSION In the COMPANION trial , patients with moderate to severe HFrEF and a history of IAF/AFL had no benefit from CRT OBJECTIVES The main objective of this study was to assess if the benefits of biventricular ( BiV ) pacing observed during the crossover phase were sustained over 12 months . BACKGROUND MUltisite STimulation In Cardiomyopathies ( MUSTIC ) is a r and omized controlled study intended to evaluate the effects of BiV pacing in patients with New York Heart Association ( NYHA ) class III heart failure and intraventricular conduction delay . METHODS Of 131 patients included , 42/67 in sinus rhythm ( SR ) and 33/64 in atrial fibrillation ( AF ) were followed up longitudinally at 9 and 12 months by 6-min walked distance , peak oxygen uptake ( peak VO(2 ) ) , quality of life by the Minnesota score , NYHA class , echocardiography , and left ventricular ejection fraction by radionuclide technique . RESULTS At 12 months , all SR and 88 % of AF patients were programmed to BiV pacing . Compared with baseline , the 6-min walked distance increased by 20 % ( SR ) ( p = 0.0001 ) and 17 % ( AF ) ( p = 0.004 ) ; the peak VO(2 ) by 11 % ( SR ) and 9 % ( AF ) ; quality of life improved by 36 % ( SR ) ( p = 0.0001 ) and 32 % ( AF ) ( p = 0.002 ) ; NYHA class improved by 25 % ( SR ) ( p = 0.0001 ) and 27 % ( AF ) ( p = 0.0001 ) . The ejection fraction improved by 5 % ( SR ) and 4 % ( AF ) . Mitral regurgitation decreased by 45 % ( SR ) and 50 % ( AF ) . CONCLUSIONS The clinical benefits of BiV pacing appeared to be significantly maintained over a 12-month follow-up period Background —Whether adding cardiac resynchronization therapy ( CRT-D ) to an implanted cardioverter – defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias ( AF/AT ) , or if postimplantation AF/AT modulate the benefits of CRT-D , remain unknown . Methods and Results —We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial ( RAFT ) participants without permanent AF , who were r and omized to CRT-D ( n=495 ) versus nonresynchronization defibrillator ( implanted cardioverter – defibrillator ; n=477 ) within the predefined stratum eligible for an atrial lead . Occurrence of postr and omization AF/AT was prospect ively assessed , and Cox models were used to test the independent association between the postr and omization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure . Over 41 ( ±19 ) months , postr and omization AF/AT occurred in 216 ( 45.3 % ) patients r and omized to implanted cardioverter – defibrillator and 249 ( 50.3 % ) r and omized to CRT-D. After adjusting for competing risk of death , r and omization to CRT-D increased risk of postr and omization AF/AT ( hazard ratio , 1.20 ; 95 % confidence interval , 1.00–1.42 ; P=0.045 ) . Postr and omization AF/AT , which remained paroxysmal in 69.5 % , did not reduce biventricular pacing percentage . In adjusted models , postr and omization AF/AT was not associated with the primary outcome ( hazard ratio , 1.04 ; 95 % confidence interval , 0.84–1.30 ) . However , AF/AT was associated with a borderline decreased risk of mortality ( hazard ratio , 0.75 ; 95 % confidence interval , 0.58–1.00 ) but increased risk of heart failure hospitalization ( hazard ratio , 1.43 ; 95 % confidence interval , 1.08–1.90 ) . Conclusions —In RAFT , nearly half of the patients developed postr and omization AF/AT , and those r and omized to CRT-D had borderline significant higher risk . Postr and omization AF/AT was associated with risk of heart failure hospitalization , but not with the primary composite outcome . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00251251 Background — Atrial fibrillation/flutter ( AF ) and heart failure often coexist ; however , the effect of cardiac resynchronization therapy ( CRT ) on the incidence of AF and on the outcome of patients with new-onset AF remains undefined . Methods and Results — In the CArdiac REsynchronisation in Heart Failure ( CARE-HF ) trial , 813 patients with moderate or severe heart failure were r and omly assigned to pharmacological therapy alone or with the addition of CRT . The incidence of AF was assessed by adverse event reporting and by ECGs during follow-up , and the impact of new-onset AF on the outcome and efficacy of CRT was evaluated . By the end of the study ( mean duration of follow-up 29.4 months ) , AF had been documented in 66 patients in the CRT group compared with 58 who received medical therapy only ( 16.1 % versus 14.4 % ; hazard ratio 1.05 ; 95 % confidence interval , 0.73 to 1.50 ; P=0.79 ) . There was no difference in the time until first onset of AF between groups . Mortality was higher in patients who developed AF , but AF was not a predictor in the multivariable model ( hazard ratio 1.17 ; 95 % confidence interval , 0.82 to 1.67 ; P=0.37 ) . In patients with new-onset AF , CRT significantly reduced the risk for all-cause mortality and all other predefined end points and improved ejection fraction and symptoms ( no interaction between AF and CRT ; all P>0.2 ) . Conclusions — Although CRT did not reduce the incidence of AF , CRT improved the outcome regardless of whether AF developed Objective : To compare the effects of cardiac resynchronisation therapy ( CRT ) in patients with heart failure ( HF ) in either atrial fibrillation ( AF ) or sinus rhythm ( SR ) . Design : Prospect i ve observational study . Patients : 295 consecutive patients with HF ( permanent AF in 66 , paroxysmal AF in 20 , SR in 209 ; New York Heart Association ( NYHA ) class III or IV ; left ventricular ejection fraction ( LVEF ) ⩽35 % , QRS ⩾120 ms ) . Interventions : All patients underwent CRT without atrioventricular junction ablation . Main outcome measures : The primary end point was the composite of cardiovascular death or unplanned hospitalisation for major cardiovascular events . Secondary end points included the composite of cardiovascular death or hospitalisation for worsening HF . Cardiovascular mortality , total mortality and changes in NYHA class , 6-minute walking distance , quality of life ( Minnesota Living with Heart Failure question naire ) and echocardiographic variables were 
    Output:
    