{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T09:47:10Z","timestamp":1774691230195,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sobolev Institute of Mathematics SB RAS","award":["FWNF-2024-0002"],"award-info":[{"award-number":["FWNF-2024-0002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2013defibrillator function (CRT-D). Methods: This prospective single-center cohort study included 101 patients with chronic heart failure (mean age 62 \u00b1 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.<\/jats:p>","DOI":"10.3390\/jcm14248938","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T10:06:56Z","timestamp":1766052416000},"page":"8938","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Outcomes of Drug-Refractory Atrial Fibrillation After Atrioventricular Node Ablation Combined with Implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D)"],"prefix":"10.3390","volume":"14","author":[{"given":"Bagdat A.","family":"Akhyt","sequence":"first","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Medicine\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salim F.","family":"Berkinbaev","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Postgraduate Education, National Joint-Stock Company \u201cKazakh National Medical University Named After S.D. Asfendiyarov\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4832-3197","authenticated-orcid":false,"given":"Natalya G.","family":"Lozhkina","sequence":"additional","affiliation":[{"name":"Federal Research Center for Fundamental and Translational Medicine, Novosibirsk 630117, Russia"},{"name":"Federal State Autonomous Educational Institution of Higher Professional Education Novosibirsk National Research State University, Novosibirsk 630090, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8586-8938","authenticated-orcid":false,"given":"Sergey N.","family":"Artemenko","sequence":"additional","affiliation":[{"name":"Federal Research Center for Fundamental and Translational Medicine, Novosibirsk 630117, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolay Yu.","family":"Zyatkov","sequence":"additional","affiliation":[{"name":"S.L. Sobolev Institute of Mathematics, Siberian Branch, Russian Academy of Sciences, Novosibirsk 630090, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-4988","authenticated-orcid":false,"given":"Olga I.","family":"Krivorotko","sequence":"additional","affiliation":[{"name":"S.L. Sobolev Institute of Mathematics, Siberian Branch, Russian Academy of Sciences, Novosibirsk 630090, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kulzida M.","family":"Koshumbayeva","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Medicine\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marat O.","family":"Pashimov","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Medicine\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rustem M.","family":"Tuleutayev","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Medicine\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6182-5933","authenticated-orcid":false,"given":"Elmira B.","family":"Kultanova","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Medicine\u201d, Almaty 050000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100786","DOI":"10.1016\/j.lanepe.2023.100786","article-title":"Atrial fibrillation: Epidemiology, screening and digital health","volume":"37","author":"Linz","year":"2024","journal-title":"Lancet Reg. 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