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Dickstein K, Vardas PE, Auricchio A, et al. 2010 focused update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur J Heart Fail 2010; 12:1143. 17. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33:1787. 18. Khan MN, Ja s P, Cummings J, et al. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 2008; 359:1778. 19. Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 378:417. 20. Kamath GS, Cotiga D, Koneru JN, et al. The utility of 12-lead Holter monitoring in patients with permanent atrial fibrillation for the identification of nonresponders after cardiac resynchronization therapy. J Am Coll Cardiol 2009; 53:1050. 21. Curtis AB, Worley SJ, Adamson PB, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013; 368:1585. 22. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cftopic/pma/pma.cfm?num=p030035 (A ccessed on September 19, 2014). 23. Leon AR, Greenberg JM, Kanuru N, et al. Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 2002; 39:1258. 24. Brignole M, Gammage M, Puggioni E, et al. Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 2005; 26:712. 25. Doshi RN, Daoud EG, Fellows C, et al. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 2005; 16:1160. https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 13/18 7/5/23, 9:12 AM Cardiac resynchronization therapy in atrial fibrillation - UpToDate 26. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352:1539. 27. Tang AS, Wells GA, Talajic M, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010; 363:2385. 28. Healey JS, Hohnloser SH, Exner DV, et al. Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT). Circ Heart Fail 2012; 5:566. 29. Upadhyay GA, Choudhry NK, Auricchio A, et al. Cardiac resynchronization in patients with atrial fibrillation: a meta-analysis of prospective cohort studies. J Am Coll Cardiol 2008; 52:1239. 30. Linde C, Leclercq C, Rex S, et al. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002; 40:111. 31. Khadjooi K, Foley PW, Chalil S, et al. Long-term effects of cardiac resynchronisation therapy in patients with atrial fibrillation. Heart 2008; 94:879. 32. Delnoy PP, Ottervanger JP, Luttikhuis HO, et al. Comparison of usefulness of cardiac resynchronization therapy in patients with atrial fibrillation and heart failure versus patients with sinus rhythm and heart failure. Am J Cardiol 2007; 99:1252. 33. Khazanie P, Hammill BG, Qualls LG, et al. Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE. Circ Heart Fail 2014; 7:926. 34. Wilton SB, Leung AA, Ghali WA, et al. Outcomes of cardiac resynchronization therapy in patients with versus those without atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm 2011; 8:1088. 35. Gasparini M, Auricchio A, Regoli F, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol 2006; 48:734. 36. Gasparini M, Auricchio A, Metra M, et al. Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation. Eur Heart J 2008; 29:1644. 37. Hayes DL, Boehmer JP, Day JD, et al. Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm 2011; 8:1469. https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 14/18 7/5/23, 9:12 AM Cardiac resynchronization therapy in atrial fibrillation - UpToDate 38. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288:3115. 39. Brignole M, Botto G, Mont L, et al. Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J 2011; 32:2420. Topic 3515 Version 19.0 https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 15/18 7/5/23, 9:12 AM Cardiac resynchronization therapy in atrial fibrillation - UpToDate GRAPHICS NYHA and other classifications of cardiovascular disability Canadian NYHA functional [1] Cardiovascular Specific activity Class [3] classification Society functional scale [2] classification I Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous or rapid Patients can perform to completion any activity requiring 7 metabolic equivalents (ie, can carry 24 lb up 8 steps; do outdoor work undue fatigue, palpitation, dyspnea, or anginal pain. prolonged exertion at work or recreation. [shovel snow, spade soil]; do recreational activities [skiing, basketball, squash, handball, jog/walk 5 mph]). II Patients with cardiac disease resulting in Slight limitation of ordinary activity. Patients can perform to completion any activity requiring 5 metabolic equivalents (eg, have sexual intercourse without stopping, garden, rake, weed, roller skate, dance slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, Walking or climbing stairs rapidly, walking uphill, walking or stair- climbing after meals, in cold, in wind, or when under emotional dyspnea, or anginal pain. stress, or only during the few hours after awakening. Walking more than 2 blocks on the level and climbing more than 1 flight of foxtrot, walk at 4 mph on level ground) but cannot and do not perform to completion activities requiring 7 metabolic equivalents. ordinary stairs at a normal pace and in normal conditions. III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Marked limitation of ordinary physical activity. Walking 1 to 2 blocks on the level and climbing 1 flight in Patients can perform to completion any activity requiring 2 metabolic equivalents (eg, shower without stopping, strip Less-than-ordinary normal conditions. and make bed, clean https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 16/18 7/5/23, 9:12 AM Cardiac resynchronization therapy in atrial fibrillation - UpToDate physical activity causes fatigue, palpitation, dyspnea, or anginal pain. windows, walk 2.5 mph, bowl, play golf, dress without stopping) but cannot and do not perform to completion any activities requiring >5 metabolic equivalents. IV Patients with cardiac disease resulting in inability to carry on any physical activity Inability to carry on any physical activity without discomfort. Anginal syndrome may Patients cannot or do not perform to completion activities requiring >2 metabolic without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity be present at rest. equivalents. Cannot carry out activities listed above (specific activity scale III). is undertaken, discomfort is increased. NYHA: New York Heart Association. References: 1. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the th Heart and Great Vessels, 9 ed, Little, Brown & Co, Boston 1994. p.253. 2. Campeau L. Grading of angina pectoris. Circulation 1976 54:522. 3. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantages of a new speci c activity scale. Circulation 1981; 64:1227. Graphic 52683 Version 19.0 https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 17/18 7/5/23, 9:12 AM Cardiac resynchronization therapy in atrial fibrillation - UpToDate Contributor Disclosures E Kevin Heist, MD, PhD Equity Ownership/Stock Options: Oracle Health [Device diagnostics]. Consultant/Advisory Boards: Biotronik [Cardiac resynchronization therapy and atrial fibrillation]; Boston Scientific [Cardiac resynchronization therapy and atrial fibrillation]. All of the relevant financial relationships listed have been mitigated. Frederick Masoudi, MD, MSPH, FACC, FAHA Consultant/Advisory Boards: Bristol Meyers Squibb [Hypertrophic cardiomyopathy]; Colorado Prevention Center [Diabetes trial steering committee, study sponsor, Better Therapeutics]; TurningPoint [Utilization policy review]. Other Financial Interest: American College of Cardiology [Cardiovascular disease]; Massachusetts Medical Society [Cardiovascular disease]. All of the relevant financial relationships listed have been mitigated. Bradley P Knight, MD, FACC Grant/Research/Clinical Trial Support: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; MDT [Electrophysiology]; Philips [Electrophysiology]. Consultant/Advisory Boards: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; CVRx [Heart failure]; MDT [Electrophysiology]; Philips [Electrophysiology]; Sanofi [Arrhythmias]. Speaker's Bureau: Abbott [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Transeptal catheterization]; BSCI [Electrophysiology]; MDT [Electrophysiology]. All of the relevant financial relationships listed have been mitigated. Todd F Dardas, MD, MS No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/cardiac-resynchronization-therapy-in-atrial-fibrillation/print 18/18