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Catheter ablation for persistent atrial fibrillation with left ventricular systolic dysfunction: Who is the best
Lu Yu1, Ruhong Jiang1, Yaxun Sun1
1Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Insights
Catheter ablation effectively improves heart function in persistent atrial fibrillation (PerAF) patients with heart failure (HF). Early ablation is beneficial for those with moderate LV dilation and higher heart rates.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Tachycardia-induced cardiomyopathy is often unrecognized before ablation.
- Optimal patient selection and timing for catheter ablation in persistent atrial fibrillation (PerAF) with heart failure (HF) remain unclear.
Purpose of the Study:
- To evaluate the effectiveness of catheter ablation in patients with PerAF and heart failure.
- To identify predictors of left ventricular (LV) systolic function recovery post-ablation.
Main Methods:
- Retrospective analysis of consecutive patients with PerAF and LVEF <50% undergoing AF ablation.
- Assessment of LV size, heart rate (HR), and LVEF impact on LV systolic function recovery post-ablation.
Main Results:
- LVEF improvement was similar across different LV sizes and HR control groups.
- LV systolic function recovery was higher in patients with normal to moderate LV dilation, HR ≥80 bpm, and HFmrEF.
- Overall AF freedom rates were comparable across various subgroups.
Conclusions:
- Catheter ablation is effective for PerAF with HF, irrespective of LV dilation, rate control, or HFrEF.
- Patients with normal to moderate LV dilation, resting HR ≥80 bpm, and HFmrEF are potential candidates for early PerAF ablation to normalize LVEF.
Background:
Tachycardia-induced cardiomyopathy is poorly recognized pre-ablation. It remains unclear of better patient selection and timing for catheter ablation in persistent atrial fibrillation (PerAF) with heart failure (HF).
Methods:
Consecutive patients with PerAF and left ventricular ejection fraction (LVEF) <50% referred for AF ablation were retrospectively included. The impact of LV size, heart rate (HR), and LVEF pre-ablation were analyzed for assessing LV systolic function recovery, defined as LVEF increase of ≥20% or to a value ≥55% after ablation.
Results:
A total of 120 patients (2017-2020) were included. After 19 ±14 months post ablation, LVEF improvement was similar in patients with normal or dilated LV (18.3 ± 9.4% vs. 16.1 ± 10.8%, P = .25), rapid or controlled HR (19.5 ± 10% vs. 16.1 ± 10%, P = .09), but higher in HFrEF (HF with reduced EF) than HFmrEF (HF with midrange EF) (21.6 ± 10.3% vs. 14.9 ± 9.3%, P < .01). There was more LV systolic function recovery in those with normal to moderate LV dilation (80%, odds ratio [OR] 15.22, P < .01), HR ≥80 bpm (79%, OR 5.38, P < .01) and HFmrEF (80%, OR 4.03, P < .01). The overall AF freedom was similar between normal and dilated LV (59% vs. 62%, P = .95), rapid and controlled HR (67% vs. 56%, P = .18), and HFmrEF and HFrEF (65% vs. 50%, P = .19).
Conclusion:
Catheter ablation is effective independent of LV dilation, rate control or HFrEF. Patients with normal to moderate LV dilation, resting HR ≥80 bpm and HFmrEF may be candidates for early PerAF ablation to achieve LVEF normalization.
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