Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation

Abstract

AimsThe objective of the study was to analyse the influence of left ventricular (LV) ejection fraction (EF) on the outcomes of atrial fibrillation (AF) ablation after a first procedure. Pre-procedural predictors of recurrences after AF ablation can be useful for patient information and selection of candidates. The independent influence of LV systolic dysfunction on recurrence rate has not been studied.Methods and resultsA case–control study (1:1) was conducted with a total of 72 patients: 36 cases (depressed LVEF) and 36 controls (normal LVEF). Patients were matched by left atrial diameter (LAD), the presence of arterial hypertension, and other variables that might influence the results (age, gender and paroxysmal vs. persistent AF). There were no statistical differences in the variables used to perform the matching. Patients with depressed LVEF had higher LV end diastolic diameter (55.6 ± 6.2 vs. 52.4 ± 5.5, P = 0.03), higher LV end systolic diameter (40.3 ± 6.9 vs. 32.6 ± 4.3, P < 0.001), lower LVEF (41.4 ± 8.0 vs. 63.1 ± 5.5, P < 0.001) and were more likely to have structural heart disease. After a mean follow-up of 16 ± 13 months, survival analysis for AF recurrences showed no differences between patients with depressed vs. normal LVEF (50.0 vs. 55.6%, log rank = 0.82). Cox regression analysis revealed LAD to be the only variable correlated to recurrence [OR 1.11 (1.01–1.22), P = 0.03]. Analysis at 6 months showed a significant increase in LVEF (43.23 ± 7.61 to 51.12 ± 13.53%, P = 0.01) for the case group.ConclusionLV systolic dysfunction by itself is not a predictor of outcome after AF ablation. LAD independently correlates with outcome in patients with low or normal LVEF.

Catheter Ablation of Atrial Fibrillation in Chronic Heart Failure: A Contemporary Review

“…Several studies reported on improvement in LV systolic function, quality of life, exercise tolerance and functional class, mitral regurgitation, reduction of heart failure hospitalizations and incidence of stroke. [16][17][18][19][22][23][24][25][26][27][28][31][32][33] Two studies selectively focused on patients with TCM, specifically 113 individuals. AF ablation efficacy at followup (six to 18 months) was 74%, and mean LVEF significantly improved from 35% or 40% to 54%, suggesting that TCM did not increase the risk of AF recurrence.…”

Catheter Ablation of Atrial Fibrillation – Techniques and Technology

“…16 A third case controlled series reported that the efficacy of AF ablation was similar in patients with an without LV systolic dysfunction and also reported an improvement in EF at six months follow-up. 17 A recent meta-analysis reported that the single procedure efficacy of AF ablation was lower in patients with systolic dysfunction, but with repeat procedures a similar success rate could be achieved among patients with and without systolic dysfunction. 50 Overall, catheter ablation of AF is a reasonable in highly selected patients with heart failure.…”

“…1,5 Yet published data also supports a role for catheter ablation in patients who were previously deemed unsuitable. Benefit from ablation has been reported in patients with heart failure [14][15][16][17] …”

“…49 Various clinical trials have examined the role of catheter ablation of AF in congestive heart failure. 14,16,17 The initial major study to address this issue examined the role of catheter ablation in 58 patients with heart failure who had an ejection fraction (EF) of less than 45 % compared to 58 controls. 14 During a mean follow-up of 12 ± 7 months, 78 % of patients with heart failure and 84 % of controls remained in SR.…”

Catheter Ablation to Maintain Sinus Rhythm

“…A third case-control series reported that the efficacy of AF ablation was similar in patients with and without left ventricular systolic dysfunction and also reported an improvement in ejection fraction at 6-month follow-up. 41 A recent meta-analysis 42 reported that the single-procedure efficacy of AF ablation was lower in patients with systolic dysfunction, but with repeat procedures, a similar success rate could be achieved among patients with and without systolic dysfunction. Taken as a whole, the results of these studies suggest that catheter ablation of AF is reasonable in highly selected patients with heart failure.…”