Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure

Abstract

Restoration and maintenance of sinus rhythm by catheter ablation without the use of drugs in patients with congestive heart failure and atrial fibrillation significantly improve cardiac function, symptoms, exercise capacity, and quality of life.

Impact of Atrial Fibrillation on Exercise Capacity and Mortality in Heart Failure With Preserved Ejection Fraction: Insights From Cardiopulmonary Stress Testing

“…During the past few decades, several invasive and noninvasive hemodynamic studies have shed light on the role played by atrial systole and normal sinus rhythm in maintaining adequate cardiac output, particularly during exercise and in patients with heart failure 5, 8, 17, 20, 21, 22, 23. Inadequate cardiac output during AF has been attributed to several mechanisms, including loss of atrial systole, irregular ventricular rhythm with beat‐to‐beat variability, and impaired ventricular filling time 9, 17, 21, 22.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…The initial study to address this important topic was published in 2004. 232,1042 This study examined the role of catheter ablation in 58 patients with HF with an EF of less than 45% and 58 controls. During a mean follow-up of 12 ± 7 months, 78% of patients with HF and 84% of controls remained in sinus rhythm.…”

“…1193 Injury to the left PN during isolation of a persistent left SVC was not observed in several case series using RF energy. 232,1042,1194,1195 Very rarely, ablation at the roof of the LAA can result in left PN damage 1184 ; however, it was not observed in a large study in which LAA isolation was performed using RF ablation. 532,533 The incidence of PN palsy is 0.17%–0.48% with PV antrum isolation using RF ablation, even though the PN is found within the typical WACA and carina lines of the right-sided PVs in 30% of patients.…”

Pulmonary Vein Isolation Alone Versus Additional Linear Ablation in Patients With Persistent Atrial Fibrillation Converted to Paroxysmal Type With Antiarrhythmic Drug Therapy

“…In addition, results from several trials suggest that early restoration and long-term maintenance of sinus rhythm provides considerable benefits, including improvement in cardiac function and quality of life and a lower risk of death in select populations. [27][28][29][30] Furthermore, a recent study in patients with long-standing PeAF suggested that transformation from nonparoxysmal to PAF after catheter ablation may …”