Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

Abstract

BackgroundHeart failure and atrial fibrillation (AF) often coexist in a deleterious cycle.ObjectiveTo evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation.MethodsPatients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation.Results31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred.ConclusionOur findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

Analysis of Bipolar Radiofrequency Ablation in Treatment of Atrial Fibrillation Associated with Rheumatic Heart Disease

“…Tasso et al . [ 36 ] reported that the echocardiographic outcome after ablation showed significant improvement, especially in patients maintained sinus rhythm. They suggested that it may result from the recovery of atrial contraction and the disappearance of irregular ventricular rhythm.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“…When viewed cumulatively, these published results describe the outcomes of AF ablation in more than 1000 patients with HF. 233 , 234 , 235 , 236 , 237 , 384 , 385 , 386 , 387 , 388 , 389 , 390 , 391 , 392 , 393 , 394 Included within this large body of literature are four prospective, randomized clinical trials, the results of which were recently summarized in a meta-analysis. 235 , 236 , 237 , 390 , 392 A total of 224 patients were randomized, among whom 83% had persistent AF.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary

“…Indications for catheter atrial fibrillation ablation in populations of patients not well represented in clinical trials Congestive heart failure It is reasonable to use similar indications for AF ablation in selected patients with heart failure as in patients without heart failure. IIa B-R 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 Older patients (>75 years of age) It is reasonable to use similar indications for AF ablation in selected older patients with AF as in younger patients. IIa B-NR 53 , 54 , 55 , 56 , 57 , 58 , 59 Hypertrophic cardiomyopathy It is reasonable to use similar indications for AF ablation in selected patients with HCM as in patients without HCM.…”