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Updated: Apr 23, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review
Matteo Anselmino1, Mario Matta1, Fabrizio D'Ascenzo1
1From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim (T.N.); Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (G.N.); Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic (M.F.); Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy (E.B.); Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, United Kingdom (A.F., E.D.); Department of Cardiology, Westmead Hospital, Sydney, Australia (C.N.); Department of Cardiology, University of Sydney, Sydney, Australia (C.N.); Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France (P.J., R.W.); Department of Cardiology, University of Western Australia, Crawley, Western Australia (R.W.); and Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (J.M.K.).
Insights
Catheter ablation for atrial fibrillation (AF) in patients with reduced left ventricular function is safe and effective. Early intervention improves outcomes and significantly enhances heart function over the long term.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Catheter ablation for atrial fibrillation (AFCA) is a standard treatment for rhythm control.
- Limited data exist on the long-term safety and efficacy of AFCA in patients with left ventricular systolic dysfunction (LVSD).
- This meta-analysis evaluates AFCA outcomes in LVSD patients, including recurrence predictors and effects on ventricular function.
Purpose of the Study:
- To assess the safety and long-term outcomes of AFCA in patients with LVSD.
- To identify predictors of AF recurrence after AFCA in this population.
- To evaluate the impact of AFCA on left ventricular function and heart failure markers.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials, clinical trials, and observational studies.
- Included studies focused on patients with LVSD undergoing AFCA.
- Data from 26 studies involving 1838 patients were analyzed, with a mean follow-up of 23 months.
Main Results:
- The overall complication rate was 4.2%. Efficacy in maintaining sinus rhythm was 60% at follow-up.
- Early AF and heart failure diagnosis predicted higher recurrence rates, while absence of structural heart disease predicted lower rates.
- Left ventricular ejection fraction improved by 13% (P<0.001), with significant reductions in severely impaired ejection fraction (<35%) and NT-proBNP levels.
Conclusions:
- AFCA is effective for patients with impaired left ventricular systolic function, especially when performed early.
- Early AFCA offers long-term benefits, improving left ventricular function and reducing severe systolic dysfunction.
- AFCA is a valuable therapeutic option for managing atrial fibrillation in patients with heart failure.
Background:
Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function.
Methods And Results:
A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18-40) months. Overall complication rate was 4.2% (3.6%-4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%-67%). Meta-regression analysis revealed that time since first atrial fibrillation (P=0.030) and heart failure (P=0.045) diagnosis related to higher, whereas absence of known structural heart disease (P=0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (P<0.001), with a significant reduction of patients presenting an ejection fraction <35% (P<0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL (P<0.001).
Conclusions:
AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.
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