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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

Catheter ablation in selected patients with depressed left ventricular ejection fraction and persistent atrial

Agustín Bortone1, Pénélope Pujadas-Berthault, Nicole Karam

  • 1Département de Rythmologie, Unité de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|April 16, 2013
PubMed

Insights

Atrial fibrillation catheter ablation significantly improves left ventricular ejection fraction in congestive heart failure patients with persistent AF unresponsive to cardioversion. Redo procedures are often necessary for sustained sinus rhythm.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Persistent atrial fibrillation (AF) in congestive heart failure (CHF) patients can cause or worsen left ventricular (LV) dysfunction.
  • Direct current cardioversion (DCC) is often attempted to restore sinus rhythm (SR), but its success is limited in some patients.
  • Management of CHF patients with persistent AF refractory to DCC remains challenging, especially when tachycardia-mediated LV dysfunction is suspected.

Purpose of the Study:

  • To evaluate the effectiveness of AF catheter ablation in selected CHF patients with persistent AF unresponsive to DCC.
  • To assess the impact of AF ablation on LV ejection fraction (LVEF) in this specific patient group.
  • To determine if restoring SR through ablation can improve cardiac function in patients with presumed tachycardia-mediated LV dysfunction.

Main Methods:

  • A cohort of 129 CHF patients with persistent AF was screened; 34 met criteria for AF refractory to DCC and likely tachycardia-mediated LV dysfunction.
  • These 34 patients underwent stepwise AF catheter ablation procedures.
  • Patients were followed for a mean of 17.6 months post-ablation, with assessment of SR, NYHA class, and LVEF.

Main Results:

  • All 34 patients achieved SR after a mean of 1.9 ablation procedures.
  • Significant improvement in LVEF was observed, increasing from 30.4% to 54.6% within 3-6 months (P<0.0001).
  • New York Heart Association class also improved significantly from 2.8 to 1 (P<0.001), with benefits sustained during SR maintenance.

Conclusions:

  • AF catheter ablation is a beneficial treatment for selected CHF patients with persistent AF refractory to DCC.
  • The procedure leads to substantial improvement in LVEF and functional class in the majority of patients.
  • Achieving mid-term SR maintenance frequently requires repeat ablation procedures.
Abstract

Keywords:
Catheter ablationCongestive heart failurePersistent atrial fibrillation

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