Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Abstract

Background Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long‐term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF. Hypothesis We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure. Methods Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow‐up post‐ablation. Results The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow‐up period of 38.2 months (range, 5–92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence. Conclusions The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow‐up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.

Meta‐analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

“…Traditionally, CA in patients with AF and HFrEF has been deemed less desirable due to a potential lower success rate and higher procedural complications. However, the available efficacy and safety data on CA in patients with HFrEF is based mainly on small observational studies . Previous meta‐analysis by Al Halabi et al included four RCTs showed a favorable symptom and hemodynamic response to CA in this population .…”

“…HFrEF is based mainly on small observational studies. 9,[25][26][27] Previous meta-analysis by Al Halabi et al 28 included four RCTs showed a favorable symptom and hemodynamic response to CA in this population. 10,[12][13][14]28 Since that meta-analysis was published, three The included studies compared rhythm control with CA to a strategy of using medications either for rate or rhythm control, provided that there was no mortality difference between rate and rhythm control with medications in this population.…”

“…Catheter ablation (CA) has emerged as an effective therapeutic option over the last two decades for treatment of AF . Several studies have evaluated the role of AF ablation in patients with HF with reduced ejection fraction (HFrEF) and demonstrated that sinus rhythm could be often restored with a significant improvement in left ventricular ejection function (LVEF) and symptoms . However, most of these studies were small and observational.…”

“…7 Several studies have evaluated the role of AF ablation in patients with HF with reduced ejection fraction (HFrEF) and demonstrated that sinus rhythm could be often restored with a significant improvement in left ventricular ejection function (LVEF) and symptoms. 8,9 However, most of these studies were small and observational. Recently, several randomized control trials (RCTs) compared the efficacy and outcomes of CA vs medications in patients with AF and HFrEF and reported new findings.…”

Comparison of two radiofrequency ablation devices for atrial fibrillation concomitant with a rheumatic valve procedure

“…The patients were followed up at 3, 6, 12, 24, and 36 months post-operatively or whenever they developed symptoms consistent with recurrent AF. [11] Each visit consisted of a detailed history and routine clinical, electrocardiographic, and echocardiographic evaluations and laboratory testing. A 24 h Holter-ECG recording was performed at discharge and at the 6-month and 12-month follow-ups.…”