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

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Atrial fibrillation ablation and left appendage closure in heart failure patients

Minesh R Patel1, Angelo B Biviano

  • 1From the Department of Medicine, Columbia University Medical Center, New York, New York, USA.

Current Opinion in Cardiology
|March 26, 2015
PubMed

Insights

Atrial fibrillation ablation benefits heart failure patients with reduced ejection fraction. Evidence for ablation in preserved ejection fraction and for left atrial appendage closure in heart failure is limited.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) in heart failure (HF) patients increases morbidity and mortality.
  • Pharmacologic rhythm control and anticoagulation have limitations for stroke prevention.
  • Procedural alternatives like AF ablation and left atrial appendage (LAA) closure are gaining attention.

Purpose of the Study:

  • To review evidence for AF ablation in HF patients.
  • To evaluate LAA closure in HF patients.
  • To assess procedural safety and efficacy for stroke risk and hemodynamic improvement.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) and existing literature.
  • Analysis of clinical trial data on AF ablation in HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).
  • Assessment of limited RCT data on LAA closure in HF patients.

Main Results:

  • AF ablation is safe and effective in HFrEF patients, improving cardiac function, quality of life, and HF symptoms.
  • Evidence for AF ablation benefit in HFpEF patients is limited.
  • Insufficient data exists on the safety and efficacy of LAA closure in HF patients.

Conclusions:

  • AF ablation is well-tolerated and effective in HF patients, comparable to non-HF populations.
  • Consistent evidence supports AF ablation for HFrEF.
  • Limited evidence exists for AF ablation in HFpEF, and LAA closure data in HF is insufficient.
Abstract

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