August 13, 2026Journal of the American College of Cardiology371 citations
Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function
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Key Result
Following pulmonary vein isolation for atrial fibrillation, 73% of patients with impaired ejection fraction remained free of AF recurrence compared to 87% of patients with normal EF (p=0.03).
Key Points
- The aim was to evaluate the safety and efficacy of pulmonary vein isolation in atrial fibrillation patients with impaired left ventricular systolic function.
- Included 377 consecutive patients undergoing PVI from December 2000 to January 2003.
- Ninety-four patients had impaired left ventricular function (ejection fraction <40%) as the study group.
- Endpoints included AF recurrence, changes in ejection fraction, and quality of life.
- Mean ejection fraction was 36% in the impaired group compared to 54% in controls.
- 73% of patients with impaired ejection fraction remained free of AF recurrence at 14 months (p=0.03).
- Significant improvement in quality of life despite a nonsignificant increase in ejection fraction of 4.6%.
Study Design
Type
Cohort (n=377)
Structured PICO
Does pulmonary vein isolation effectively prevent atrial fibrillation recurrence and improve ejection fraction or quality of life in patients with impaired systolic function compared to those with normal systolic function?
P
Population
377 consecutive patients undergoing pulmonary vein isolation for atrial fibrillation, including 94 with impaired ejection fraction, followed for a mean of 14 months.
E
Exposure
Pulmonary vein isolation (PVI)
C
Comparator
Patients with normal ejection fraction undergoing pulmonary vein isolation
O
Outcome
Atrial fibrillation (AF) recurrencehard clinical
Pulmonary vein isolation is a feasible and effective therapeutic option for atrial fibrillation in patients with impaired systolic function, achieving a 73% freedom from recurrence at 14 months and significantly improving quality of life.
Main Result
Absolute Event Rate: 73% vs 87%
p-value: p=0.03
Limitations
- Nonrandomized design
- Small sample size
- Short follow-up duration
Abstract
OBJECTIVES: We aimed to determine the safety and efficacy of pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients with impaired left ventricular (LV) systolic function. BACKGROUND: To date, PVI has been performed primarily in patients with normal LV function. Yet, many AF patients have impaired LV systolic function. The outcomes of PVI in patients with impaired LV systolic function are unknown. METHODS: We included 377 consecutive patients undergoing PVI between December 2000 and January 2003. Ninety-four patients had impaired LV function (ejection fraction EF <40%), and they comprised the study group. The control group was the remaining 283 patients who had a normal EF. End points included AF recurrence and changes in EF and quality of life (QoL). RESULTS: Mean EF was 36% in our study group, compared with 54% in controls. After initial PVI, 73% of patients with impaired EF and 87% of patients with normal EF were free of AF recurrence at 14 +/- 6 months (p = 0.03). In the study group, there was a nonsignificant increase in EF of 4.6% and significant improvement in QoL. Complication rates were low and included a 1% risk of pulmonary vein stenosis. CONCLUSIONS: Although the AF recurrence rate after initial PVI in impaired EF patients was higher than in normal EF subjects, nearly three-fourths of patients with impaired EF remained AF-free. Although our sample size was nonrandomized, our results suggest PVI may be a feasible therapeutic option in AF patients with impaired EF. Randomized studies with more patients and longer follow-up are warranted.
Cite This Study
Chen et al. (Mon,) conducted a cohort in Atrial fibrillation (n=377). Impaired left ventricular systolic function (EF <40%) vs. Normal ejection fraction was evaluated on Freedom from atrial fibrillation recurrence (p=0.03). Following pulmonary vein isolation for atrial fibrillation, 73% of patients with impaired ejection fraction remained free of AF recurrence compared to 87% of patients with normal EF (p=0.03).