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

Akhyt B.A. Berkinbaev S.F. Lozhkina N.G. Artemenko S.N. Zyatkov N.Y. Krivorotko O.I. Koshumbayeva K.M. Pashimov M.O. Tuleutayev R.M. Kultanova E.B.
December 2025 Multidisciplinary Digital Publishing Institute (MDPI)

Journal of Clinical Medicine
2025 #14 Issue 24

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 cardioverter–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 relaxation coefficient, and degree of mitral regurgitation. The exploratory predictive model showed high accuracy (92%) in terms of classifying the outcomes. Conclusions: Atrioventricular node ablation (AVNA) combined with CRT-D was associated with the observed long-term clinical outcomes observed in patients with drug-refractory tachysystolic atrial fibrillation. The exploratory machine learning analysis identified key mortality-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.

atrial fibrillation , atrioventricular node ablation , cardiac resynchronization therapy defibrillator (CRT-D) , congestive heart failure , long-term mortality

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

JSC “Research Institute of Cardiology and Internal Medicine”
Department of Cardiology
Federal Research Center for Fundamental and Translational Medicine
Federal State Autonomous Educational Institution of Higher Professional Education Novosibirsk National Research State University
S.L. Sobolev Institute of Mathematics

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