Long-Term Outcomes of Drug-Refractory Atrial Fibrillation After Atrioventricular Node Ablation Combined with Implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D)

Long-Term Outcomes of Drug-Refractory Atrial Fibrillation After Atrioventricular Node Ablation Combined with Implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D) Full article

Journal

Journal of Clinical Medicine
ISSN: 2077-0383

Output data

Year: 2025, Number: 14, Pages: 1-16 Pages count : 16 DOI: 10.3390/jcm14248938

Tags

atrial fibrillation; atrioventricular node ablation; cardiac resynchronization therapy de-fibrillator (CRT-D); congestive heart failure; long-term mortality

Authors

Akhyt Bagdat A. ¹ , Berkinbaev Salim F. ² , Lozhkina Natalya G. ^3,4 , Artemenko Sergey N. ³ , Zyatkov Nikolay Yu. ⁵ , Krivorotko Olga I. ⁵ , Koshumbaeva Kulzida M. ¹ , Pashimov Marat O. ¹ , Tuleutayev Rustem M. ¹ , Kultanova Elmira B. ¹

Affiliations

1	JSC “Research Institute of Cardiology and Internal Medicine”, Almaty 050000, Kazakhstan
2	Department of Cardiology, Faculty of Postgraduate Education, National Joint-Stock Company “Kazakh National Medical University Named After S.D. Asfendiyarov”, Almaty 050000, Kazakhstan
3	Federal Research Center for Fundamental and Translational Medicine, Novosibirsk 630117, Russia
4	Federal State Autonomous Educational Institution of Higher Professional Education Novosibirsk National Research State University, Novosibirsk 630090, Russia
5	S.L. Sobolev Institute of Mathematics, Siberian Branch, Russian Academy of Sciences, Novosibirsk 630090, Russia

Funding (1)

Sobolev Institute of Mathematics

FWNF-2024-0002

Objective: In this study, we aimed to determine the most significant risk factors for 5-year mortality in patients with paroxysmal and persistent drug-refractory tachysystolic atrial fibrillation after undergoing atrioventricular node ablation (AVNA) in combination with the implantation of a permanent three-chamber pacemaker with an implantable cardi-overter–defibrillator function (CRT-D). Methods: This prospective single-center cohort study included 101 patients with chronic heart failure (mean age 62 ± 15.5 years; 70.3% male) with paroxysmal or persistent drug-refractory atrial fibrillation who underwent atrioventricular node ablation and CRT-D implantation. All patients received optimal medical therapy before and after undergoing the procedure. Predictors of 5-year mortality were assessed using exploratory machine-learning methods, including random forest and Shapley additive explanations. Results: During 5-year follow-up, 13 cardiovascular deaths were recorded. Five key predictors of mortality were identified: left ventricular ejection fraction, 6 min walk distance, mean pulmonary artery pressure, systolic relaxa-tion coefficient, and degree of mitral regurgitation. The exploratory predictive model showed high accuracy (92%) in terms of classifying the outcomes. Conclusions: Atrio-ventricular node ablation (AVNA) combined with CRT-D was associated with the ob-served long-term clinical outcomes observed in patients with drug-refractory tachysystolic atrial fibrillation. The exploratory machine learning analysis identified key mortali-ty-associated factors, which may support future efforts in personalized risk stratification and hypothesis generation. The combination of AVNA and CRT-D was associated with the observed long-term outcomes in this real-world cohort

Akhyt B.A. , Berkinbaev S.F. , Lozhkina N.G. , Artemenko S.N. , Zyatkov N.Y. , Krivorotko O.I. , Koshumbaeva K.M. , Pashimov M.O. , Tuleutayev R.M. , Kultanova E.B.
Long-Term Outcomes of Drug-Refractory Atrial Fibrillation After Atrioventricular Node Ablation Combined with Implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D)
Journal of Clinical Medicine. 2025. N14. P.1-16. DOI: 10.3390/jcm14248938 WOS Scopus

Submitted:	Nov 17, 2025
Accepted:	Dec 9, 2025
Published print:	Dec 18, 2025
Published online:	Dec 18, 2025

Web of science:	WOS:001646806700001
Scopus:	2-s2.0-105026017124

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