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Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to
Yong-Mei Cha1, Anita Wokhlu, Samuel J Asirvatham
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. ycha@mayo.edu
Insights
Radiofrequency ablation for atrial fibrillation (AF) may improve quality of life and heart function in patients with left ventricular (LV) dysfunction. However, recurrence risk is higher in these patients compared to those with normal LV function.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Radiofrequency ablation (RFA) efficacy for atrial fibrillation (AF) in patients with left ventricular (LV) systolic or diastolic dysfunction remains unclear.
- Existing research often excludes patients with impaired LV function.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of RFA for drug-refractory AF in patients stratified by LV function.
- To compare AF elimination rates, functional improvements, and recurrence risks across different LV dysfunction groups.
Main Methods:
- Prospective cohort study comparing three groups: systolic dysfunction (LVEF ≤40%), isolated diastolic dysfunction (LVEF ≥50%), and normal LV function.
- Primary endpoint: antiarrhythmic drug (AAD)-free AF elimination at 1 year post-ablation.
- Secondary endpoints included AF control on/off AADs, changes in LVEF, diastolic function improvement, and arrhythmia recurrence.
Main Results:
- AAD-free AF elimination at 1 year was achieved in 62% with systolic dysfunction, 75% with diastolic dysfunction, and 84% of controls (P=0.007).
- Patients with systolic dysfunction showed improved LVEF in 49%, and 30% with diastolic dysfunction improved their diastolic function grade.
- Increased recurrence risk was observed in both systolic (RR 1.8) and diastolic dysfunction (RR 1.7) groups compared to controls.
Conclusions:
- RFA for AF in patients with LV systolic or diastolic dysfunction is associated with a higher long-term arrhythmia recurrence risk.
- Despite increased recurrence, RFA offers potential for significant quality-of-life improvement and beneficial LV functional changes in these patient populations.
Background:
The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain.
Methods And Results:
A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; and 100 patients with normal LV function. The primary end point was AAD-free AF elimination at 1 year after ablation. This end point was achieved in 62% of patients with systolic dysfunction, 75% of those with diastolic dysfunction, and 84% of controls (P=0.007). AF control on or off AADs was achieved in 76% of patients with systolic dysfunction, 85% of those with diastolic dysfunction, and 89% of controls (P=0.08). In the systolic dysfunction group, 49% experienced an increase in LVEF by ≥5% after ablation, of which 64% achieved normal LVEF. In the diastolic dysfunction group, 30% of patients demonstrated at least 1 grade improvement in diastolic dysfunction. Multivariable analysis demonstrated an increased relative risk of arrhythmia recurrence of 1.8 (95% CI, 1.1 to 3.1; P=0.02) in systolic dysfunction and 1.7 (1.0 to 2.7; P=0.04) in isolated diastolic dysfunction compared with normal function.
Conclusions:
Although an ablative approach for AF in patients with systolic or diastolic dysfunction is associated with an increased long-term recurrence risk, there is potential for substantial quality-of-life improvement and LV functional benefit.
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