The Impact of Known Heart Disease on Long‐Term Outcomes of Catheter Ablation in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction: A Multicenter International Study

Prabhu, Sandeep; Ling, L.; Ullah, Waqas; Hunter, Ross J.; Schilling, Richard J.; McLellan, A.; Earley, Mark J.; Sporton, Simon; Voskoboinik, A.; Blusztein, David; Mariani, Justin A.; Lee, Geoffrey; Taylor, Andrew J.; Kalman, Jonathan M.

doi:10.1111/jce.12899

Cited by 26 publications

(13 citation statements)

References 30 publications

(78 reference statements)

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“…A systematic review has shown greater improvement in ventricular function in cohorts with less ischemic disease undergoing catheter ablation for AF . This finding was consistent in a recent, smaller cohort (n = 100) in which improved AF control was observed in patients with idiopathic cardiomyopathy undergoing ablation, compared to patients with known causes of structural heart disease . Similar to our study findings, there was no difference in outcomes between patients with ischemic and nonischemic cardiomyopathy in CASTLE‐AF .…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

Black‐Maier

Steinberg

Trulock

et al. 2020

Journal of Arrhythmia

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Background: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs nonischemic heart failure. Methods:We conducted a retrospective, observational cohort study of patients with HF who underwent AF ablation. Outcomes were compared based on HF etiology and included in-hospital events, symptoms (Mayo AF Symptom Inventory [MAFSI]), and functional status (New York Heart Association class) and freedom from atrial arrhythmias at 12 months.Results: Among 242 patients (n = 70 [29%] ischemic, n = 172 [71%] nonischemic), patients with nonischemic cardiomyopathy were younger (mean age 64 ± 11.5 vs 69 ± 9.1, P = .002), more often female (36% vs 17%, P = .004), and had higher mean leftventricular ejection fraction (47% vs 42%, P = .0007). There were no significant differences in periprocedural characteristics, including mean procedure time (243 ± 74.2 vs 259 ± 81.8 minutes, P = .1) and nonleft atrial ablation (17% vs 20%, P = .6). All-cause adverse events were similar in each group (15% vs 17%, P = .7). NYHA and MAFSI scores improved significantly at follow-up and did not differ according to HF etiology (P = .5; P = .10-1.00 after Bonferroni correction). There were no significant differences in freedom from recurrent atrial arrhythmia at 12-months between ischemic (74%) and nonischemic patients (78%): adjusted RR 0.63, 95% confidence interval 0.33-1.19. Conclusions:Catheter ablation in patients with AF and concomitant heart failure leads to significant improvements in functional and symptom status without significant differences between patients with ischemic vs nonischemic HF etiology. | 85BLACK-MAIER Et AL.

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Section: Discussionsupporting

confidence: 91%

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

Black‐Maier

Steinberg

Trulock

et al. 2020

Journal of Arrhythmia

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“…Our study adds to the results of Mansour et al ., highlighting the importance of identifying predictors of repeat CA, given that the majority of resources utilized postindex CA were allocated to patients requiring repeat CA . Predictors of lower single procedure CA success rate, such as presence of left ventricular dysfunction, are likely to be associated with greater health care resource utilization . Further reductions in health care resource utilization may be expected following CA as technological advances in recent years have improved our ability to achieve greater success rates.…”

Section: Discussionmentioning

confidence: 99%

“…20 Predictors of lower single procedure CA success rate, such as presence of left ventricular dysfunction, are likely to be associated with greater health care resource utilization. 21 The management of AF imposes a large burden on health care systems. AF ablation has been shown to reduce symptoms and recurrences of AF.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization

Samuel

Tsadok

Joza

et al. 2017

Cardiovasc electrophysiol

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“…[ 31 ] Recent study also suggested that CA was less effective in patients with known heart disease (defined as myocardial infarction, valvular heart disease, or hypertrophic cardiomyopathy) than in patients with idiopathic dilated cardiomyopathy. [ 32 ] Patients with “AF-induced cardiomyopathy” are more likely to benefit from RhC strategies; however, identification of patients who were most likely to respond to CA remains a challenge. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation versus rate control in patients with atrial fibrillation and heart failure

et al. 2017

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Many trials have shown improvements in left ventricular function, exercise capacity, and quality of life after catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). We sought to evaluate the impact of CA on hard outcomes in a retrospective cohort study. AF patients with symptomatic HF from 3 hospitals were included. Our primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause mortality, stroke, and unplanned hospitalization. In total, 90 patients underwent CA and 304 ones received rate control (RaC) were included. After a mean follow-up of 13.5 ± 5.3 months, 82.2% of patients in CA group got freedom from AF; all patients in RaC group remained in AF. CA group had a significant decreased risk of MACEs compared with RaC group (13.3% vs 29.3%, hazard ratio [HR] 0.51, 95% confidence interval [CI]: 0.32–0.82, P = .005). After propensity score matched for confounding factors, difference in MACEs remained significant between groups (13.3% vs 25.6%, HR 0.50, 95% CI: 0.26–0.98, P = .044). Multivariate regression analysis also indicated that CA was significantly associated with a lower risk of MACEs in overall cohort (HR 0.486, 95% CI: 0.253–0.933, P = .030) and in propensity-matched cohort (HR 0.482, 95% CI: 0.235–0.985, P = .045). Besides, age and NYHA class were associated with an increased risk of MACEs. In conclusion, the present study demonstrated that CA for AF in HF patients could reduce the risk of MACEs in a mid-term follow-up. Thus, CA may be a reasonable option for this population.

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The Impact of Known Heart Disease on Long‐Term Outcomes of Catheter Ablation in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction: A Multicenter International Study

Abstract: IDCM was associated with greater AF control, and improvement in symptoms and LVEF compared to patients with KHD post-AF ablation. AF is an important reversible cause of HF in patients with an unexplained CM and catheter ablation an effective treatment option.

Cited by 26 publications

References 30 publications

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

Catheter ablation for the treatment of atrial fibrillation is associated with a reduction in health care resource utilization

Catheter ablation versus rate control in patients with atrial fibrillation and heart failure

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