Response to Letter Regarding Article, “Cardiac Resynchronization Therapy in Patients With Permanent Atrial Fibrillation: Results From the Resynchronization for Ambulatory Heart Failure Trial (RAFT)”

We appreciate Drs Gasparini and Boriani’s letter1 and their work to clarify the role of cardiac resynchronization therapy (CRT) in patients with permanent atrial fibrillation. However, we feel that the conclusions they make are far too definitive, considering that they are based entirely on observational data. The majority of patients in Ganesan et al’s2 meta-analysis did not have atrioventricular (AV) node ablation; thus, important biases may have influenced the decision to undertake this intervention, which might also have been associated with a more favorable outcome. Indeed, Ganesan et al’s2 own conclusion was that AV nodal ablation is “worthy of investigation in a randomized controlled trial.” Far too often in cardiology has there …