Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of
Maojing Wang1, Shanglang Cai1, Wei Ding2
1Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Insights
Catheter ablation is more effective than cardioversion for maintaining sinus rhythm and improving heart function in patients with persistent atrial fibrillation and heart failure. Patients with worse baseline cardiac function and ventricular rate control benefited most from ablation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Persistent atrial fibrillation (AF) with systolic heart failure poses significant management challenges.
- Optimizing rhythm control and cardiac function is crucial for these patients.
Purpose of the Study:
- To compare catheter ablation versus direct current cardioversion (DCC) for persistent AF in patients with left ventricular systolic dysfunction.
- To identify baseline predictors of successful ablation outcomes.
Main Methods:
- A single-center study of 97 patients with persistent AF and LVEF <50% comparing DCC (n=40) with pulmonary vein isolation (PVI) ablation (n=57).
- Recurrence treatment involved additional ablation lines. Outcomes assessed at 12 months included sustained sinus rhythm (SR) and cardiac function (LVEF, NYHA class).
Main Results:
- Catheter ablation achieved significantly higher 12-month SR maintenance rates (68.42% vs. 35%, P=0.001) compared to DCC.
- Ablation also led to significant improvements in LVEF and NYHA class.
- Improved LVEF post-ablation was associated with worse baseline ventricular rate control and cardiac function.
Conclusions:
- Catheter ablation is superior to DCC for achieving sustained SR and improving cardiac function in persistent AF with heart failure.
- Tachycardia-induced cardiomyopathy may play a significant role in patients who show substantial LVEF improvement after ablation.
Objective:
To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation.
Methods:
From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) <50%) underwent DCC followed by amiodarone (n = 40) or circumferential pulmonary vein isolation (PVI; n = 57) according to patient's preference were recruited in the study. Post-ablation recurrence was treated with atrial roof and mitral isthmus lines ablation with or without PVI based on restoration or not of pulmonary vein (PV) potential conduction. Study outcomes were 12-month rate of sustained sinus rhythm (SR) and cardiac function. Baseline characteristics were compared between patients with and without cardiac function improvement post ablation.
Results:
With similarly distributed characteristics at baseline, ablation (mean 1.8 procedures) relative to DCC yielded significantly higher level of 12-month SR maintenance rate (68.42% vs. 35%, P = 0.001); and better LVEF and New York Heart Association class. with significant effect for DCC only in maintained SR cases. Post ablation LVEF increased (>20% or to over 55%) in 31 (54.39%) patients with worse baseline cardiac function and ventricular rate control.
Conclusions:
Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group.
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