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INTRODUCTION : Anecdotal reports of spontaneous resumption to stable sinus rhythm (SR) of heart failure (HF) patients with permanent atrial fibrillation (PeAF) after cardiac resynchronization therapy (CRT) have been reported. If this incidence is appreciable, additional interventions may be indicated including placement of an atrial lead. METHODS: We retrospectively reviewed patients with PeAF who received CRT devices; standard CRT indications were applied. PeAF was defined as AF present for more than 1 year refractory to any rhythm control efforts. Rhythm was sampled at each follow-up visit, generally every 6 months. RESULTS: In total, 345 patients with PeAF were implanted with CRT devices (CRT-D 48%); mean age was 70±9 yrs and mostly male gender (83%). Ischemic HF was present in 154 patients (45%). Mean NYHA class was 3,1±0,5, 6MWT distance 308±113 meters, QRS 156±39 ms, LVEF 28±7%, and LVEDD 65±9 mm. PeAF had been present for 2,1 ± 1.6 years. Over a follow-up of 29 ± 24 months, 34 (9,9%) patients spontaneously reverted to stable (> 3 months) SR. Most SR resumptions occurred within the 1 st year after CRT (28/34, 82%), but also occured even after 5 years (2/34). Mortality rate was 20,4 for PeAF compared to 2,5 per 100 patients-year for SR resumption (Log Rank p=0.004, see figure ) (HR= 0.13, 95% CI 0.031–0.512, p< 0.0001). CONCLUSION : Spontaneous resumption to SR in HF patients with PeAF treated with CRT was observed in roughly 10% of cases, generally within 1 year from implant. SR resumption was associated with a significant 87% reduction of total mortality. Identification of predictors for return of SR may be useful to guide routine atrial lead placement in some patients.