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Updated: Oct 8, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation for Persistent Atrial Fibrillation in Class IV Systolic Heart Failure: A Single-Center Case Series

Aaron Hesselson1, Heather Hesselson2

  • 1University of Kentucky Division of Cardiovascular Medicine, 900 South Limestone Street, CTW 305D, Lexington, KY 40536.

Journal of Atrial Fibrillation
|December 24, 2021
PubMed

Insights

Catheter ablation for atrial fibrillation is feasible in patients with advanced systolic heart failure. This procedure can restore normal sinus rhythm and potentially improve heart failure status.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) management in advanced systolic heart failure (SHF) is challenging.
  • Patients with Class IV SHF are historically underrepresented in clinical ablation trials.
  • Limited data exists on the efficacy and safety of catheter ablation in this population.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of catheter ablation for persistent AF in patients with Class IV SHF.
  • To assess the impact of maintaining normal sinus rhythm (NSR) on heart failure status.

Main Methods:

  • Retrospective review of Class IV SHF patients (excluding LVAD recipients) undergoing radiofrequency ablation for AF between 2017-2020.
  • Analysis of procedural success, maintenance of NSR, and changes in heart failure status.

Main Results:

  • Seven out of ten eligible patients proceeded with catheter ablation.
  • Successful restoration of NSR was achieved in all seven patients post-procedure.
  • Five patients (71%) maintained NSR at a mean follow-up of 23 months.
  • Improved heart failure status was observed in patients maintaining NSR.

Conclusions:

  • Catheter ablation for AF in Class IV SHF patients, even on advanced therapies, is feasible.
  • The procedure can lead to improved heart failure status through sustained normal sinus rhythm.
  • Further research is warranted to confirm these findings in larger cohorts.

Keywords:
Atrial FibrillationCatheter AblationHeart Failure

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