Catheter ablation for atrial fibrillation in congestive heart failure

Hsu, Li‐Fern; Jaı̈s, Pierre; Sanders, P.

doi:10.1016/j.accreview.2005.02.013

Cited by 123 publications

(210 citation statements)

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“…46 Following on from early studies in catheter ablation in AF, a recent prospective study involving patients with CHF (n = 58) and without CHF (n = 58; ≥New York Heart Association [NYHA] Class II; left ventricular ejection fraction <45%) experienced improvements in symptoms, exercise capacity, and quality of life following the procedure (mean follow-up, 12 months). 44 The majority of patients were in sinus rhythm at the end of the follow-up period (78% of the CHF group, 84% of the control group).…”

Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 92%

“…62 In one study, conducted in patients with AF and congestive heart failure, catheterdirected AF ablation was associated with improvements in cardiac function and exercise capacity as well as in symptoms and quality of life. 44 Data available to date suggest that mortality and stroke/transient ischemic attack rates with catheterdirected, left atrial ablation and antiarrhythmic drug therapy are comparable. Meta-analysis of data from 8 randomized comparisons demonstrated a risk difference for mortality of 0.003 (95% CI: −0.018, 0.013; P = 0.74) and a risk difference for stroke/transient ischemic attack of 0.004 (95% CI: −0.010, 0.018; P = 0.54).…”

Section: Ablationmentioning

confidence: 98%

“…Other potential benefits of restoring and maintaining sinus rhythm include improvements in left ventricular (LV) function, 26,43 AF symptoms, 44 exercise tolerance, 26,35,44 -47 the ability to perform activities of daily living, 48 and quality of life. 35,44 -46,48 -50 Among those patients who underwent echocardiography at baseline and after the first and second year of follow-up in the RACE study, both rhythm (n = 175) and rate (n = 160) control were associated with improved ventricular function (LV fractional shortening) at 2 years.…”

Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 99%

“…In a catheter ablation study, significant (P = 0.03) improvements in LV function were observed in 4 of 12 patients who achieved conversion of permanent AF to paroxysmal AF. 44 Such improvements reflected increases in LVEF of ≥20% or to a value ≥55%.…”

Section: Treatment Expectations: Defining Treatment Goalsmentioning

confidence: 99%

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Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia with substantial morbidity and mortality. This review briefly describes the mechanisms of AF development and progression, including electrical, structural, and contractile remodeling. In addition, the potential benefits of achieving and maintaining sinus rhythm are discussed. For example, rhythm control has been associated with improvements in left ventricular function, AF symptoms, exercise tolerance, the ability to perform activities of daily living, and quality of life. More recently, dronedarone, a noniodinated benzofuran derivative approved for use in the treatment of AF, was shown to significantly improve clinical outcomes including cardiovascular hospitalizations and death from any cause in A Placebo‐Controlled, Double‐Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA). The review concludes with an examination of AF treatment options and expectations. Evidence suggests that the complete absence of AF recurrence is not always achievable; however, complete restoration of sinus rhythm may not be necessary for patients to achieve clinically meaningful benefits. Copyright © 2011 Wiley Periodicals, Inc.The editorial assistance provided for this manuscript was funded by Sanofi‐Aventis. The authors were fully responsible for all content and editorial decision, and received no financial support or other form of compensation related to the development of the paper. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 92%

Section: Ablationmentioning

confidence: 98%

Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 99%

Section: Treatment Expectations: Defining Treatment Goalsmentioning

confidence: 99%

See 2 more Smart Citations

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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“…113,433 Numerous studies have evaluated the efficacy of catheter ablation of both paroxysmal and persistent atrial fibrillation with significant impairment of systolic function. 437,[466][467][468][469][470][471][472][473] The weight of evidence is that sinus rhythm can be successfully achieved in 50 -80% of patients although repeat procedures are common and follow-up periods are usually not more than 12 months. Successful ablation has been associated with significant improvements in ejection fraction and reduction in atrial size in the majority of studies.…”

Section: Age and Atrial Fibrillation Ablationmentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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Update on atrial fibrillation: Part II

Savelieva

Camm

2008

Clinical Cardiology

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Antiarrhythmic drugs are an essential tool in the management of atrial fibrillation (AF). Although we are already on the threshold of a large expansion in the use of ablation therapies, these will not, however, be appropriate for all patients, and pharmacological therapies will continue to have an important place in the management of atrial fibrillation. The plethora of antiarrhythmic drugs currently available for the treatment of atrial fibrillation is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability. Improved class III antiarrhythmic drugs, such as dronedarone, new classes of antiarrhythmic agents, such as atrial repolarization delaying agents, and upstream therapies dealing with substrate, represent potential sources of new pharmacological therapies. Key words: atrial fibrillation Rate or Rhythm Control for Atrial FibrillationRecently published randomized studies comparing rate and rhythm control strategies have shown that primary rate control is not inferior to rhythm control, and furthermore, that rhythm control is more costly and inconvenient than is rate control. 1 This has led to a general movement away from rhythm control in patients who are able to tolerate the arrhythmia when the ventricular rate is adequately controlled. Primary rate control and anticoagulation are acceptable in elderly asymptomatic patients who probably constitute about 60%-70% of the atrial fibrillation (AF) population. However, in a large number of patients, there remains a genuine choice between rhythm and rate control. The primary rate control strategy is usually not appropriate in younger individuals, (i.e., less than 60-65 years) patients who are highly symptomatic, individuals with recent onset of AF, and patients with AF and associated congestive heart failure. Furthermore, the relationships between and within rate and rhythm control arms in the studies comparing the two strategies, and the reasons why rhythm control seems to be superseded by rate control, are far more complicated than has been outlined by the main reports. Analysis of subgroups showed that those who were in sinus rhythm and those who used anticoagulants survived better, while those who were treated with antiarrhythmic drugs had a higher mortality. 2 These results gave rise to speculation that the intuitive and demonstrable advantages of sinus rhythm could be offset by the toxicity of antiarrhythmic drugs and the failure to maintain adequate anticoagulation in those apparently restored to sinus rhythm. It is clear that antiarrhythmic drug therapy for rhythm control in AF patients is a complex treatment modality that requires careful patient selection, frequent monitoring for adverse effects, and potentially frequent dosage or drug changes to achieve the best results. Currently available antiarrhythmic drugs like amiodarone, sotalol, dofetilide, propafenone, and flecainide, are moderately effective at initially reducing the incidence of paroxysms or preventing persistent AF, but patients ma...

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Catheter ablation for atrial fibrillation in congestive heart failure

Cited by 123 publications

References 0 publications

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Update on atrial fibrillation: Part II

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