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Optimal Catheter Ablation Strategy for Patients with Persistent Atrial Fibrillation and Heart Failure: A

Cheng-Ming Ma1, Ye-Jian He2, Wen-Wen Li3

  • 1Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China.

Cardiology Research and Practice
|July 5, 2022
PubMed

Insights

Catheter ablation (CA) improves heart function in persistent atrial fibrillation (PeAF) and heart failure (HF) patients. However, additional ablation strategies do not enhance outcomes and increase procedure time, suggesting PVI-only is optimal.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Persistent atrial fibrillation (PeAF) and heart failure (HF) often coexist, posing treatment challenges.
  • Catheter ablation (CA) is a potential therapy, but optimal strategies for PeAF with HF remain debated.
  • Pulmonary vein isolation (PVI) is a cornerstone of CA for atrial fibrillation.

Purpose of the Study:

  • To compare the efficacy of PVI-only versus PVI plus additional ablation strategies in patients with PeAF and HF.
  • To evaluate the impact of different CA strategies on heart failure symptoms and left ventricular ejection fraction (LVEF).
  • To assess procedural outcomes, including procedure time and rehospitalization rates.

Main Methods:

  • Retrospective analysis of 118 consecutive patients with PeAF and HF undergoing CA between 2016-2020.
  • Patients were divided into PVI-only (n=56) and PVI + additional ablation (n=62) groups.
  • Transthoracic echocardiography (TTE) and clinical assessments were performed at baseline, 1 month, and 12 months post-procedure.

Main Results:

  • Both groups showed significant improvement in LVEF and left atrial diameter post-ablation compared to baseline.
  • No significant difference in HF improvement was observed between the PVI-only and PVI + additional ablation groups (71.4% vs. 74.2%, P=0.736).
  • The PVI + additional ablation group had significantly longer procedure times (137.4±7.5 min vs. 123.1±11.5 min, P=0.001) with no difference in TTE parameters or rehospitalizations.

Conclusions:

  • Catheter ablation effectively improves left ventricular function in patients with PeAF and HF.
  • Additional ablation beyond PVI does not confer additional benefits for HF improvement or other clinical outcomes.
  • PVI-only strategy is recommended due to similar efficacy and shorter procedure times, optimizing resource utilization.

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