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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Ablation vs medical therapy in the setting of symptomatic atrial fibrillation and left ventricular dysfunction

Andrew D Choi1, Khashayar Hematpour, Marrick Kukin

  • 1Al-Sabah Arrhythmia Institute and Division of Cardiology, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians & Surgeons, New York, NY, USA.

Congestive Heart Failure (Greenwich, Conn.)
|January 19, 2010
PubMed

Insights

Catheter ablation for atrial fibrillation (AF) significantly improved left ventricular (LV) function and symptoms in patients with LV dysfunction compared to medication alone. This suggests ablation is a superior treatment strategy for this patient group.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Catheter ablation for atrial fibrillation (AF) may improve left ventricular (LV) function in patients with LV dysfunction.
  • No studies have directly compared ablation to pharmacologic therapy for AF in this population.

Purpose of the Study:

  • To compare the efficacy of pulmonary vein isolation (PVI) versus medical management for AF in patients with symptomatic LV dysfunction.

Main Methods:

  • Retrospective case-control study comparing 15 patients undergoing PVI with 15 medically treated AF patients with LV dysfunction (ejection fraction ≤45%).
  • Outcomes assessed included ejection fraction and New York Heart Association (NYHA) class.

Main Results:

  • PVI group showed significant improvement in ejection fraction (37% to 50%, P=.001) and NYHA class (2.0 to 1.3, P=.01) after 16 months.
  • Medically treated group had no significant improvement in ejection fraction (34% to 36%) or NYHA class (2.0 to 1.8).

Conclusions:

  • Pulmonary vein isolation significantly improves LV function and symptoms in patients with AF and LV dysfunction compared to pharmacologic therapy.
  • These findings support a randomized clinical trial to further evaluate ablation versus medical therapy.

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