Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction

Songbing Long; Yutao Xi; Lianjun Gao; Qi Chen; Jie Cheng; Yanzong Yang; Yunlong Xia; Xiaomeng Yin

doi:10.1002/clc.23314

December 5, 2019Clinical CardiologyOpen Access

Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction

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Why the study?

Catheter ablation for AF reduces mortality in HF patients, but concerns remain that it may increase complications and raise safety issues compared with medical therapy.

Does catheter ablation reduce mortality and hospitalizations and improve heart function in atrial fibrillation patients with congestive heart failure compared to medical treatment?

Structured PICO

Does catheter ablation reduce mortality and hospitalizations and improve heart function in atrial fibrillation patients with congestive heart failure compared to medical treatment?

P

Population

420 patients with atrial fibrillation, comprising 120 with congestive heart failure undergoing their first catheter ablation (AFHF-CA), 150 with congestive heart failure on medical therapy (AFHF-Med), and 150 with normal left ventricular ejection fraction undergoing catheter ablation (AF-CA).

I

Intervention

Catheter ablation for atrial fibrillation

C

Comparator

Medical therapy (for the heart failure cohort) and catheter ablation (for the normal LVEF cohort)

O

Outcome

Maintenance of sinus rhythm, hospitalization for heart failure, mortality, and heart function improvements (LVEF, LV end-diastolic diameter, NYHA class, left atrial diameter) at 30 ± 6 monthshard clinical

Catheter ablation for atrial fibrillation in patients with congestive heart failure is safe and significantly reduces mortality and heart failure hospitalizations while improving heart function compared to medical therapy.

Implication

Ablation was associated with lower mortality and HF hospitalizations; hypothesis-generating and requires RCTs before changing practice.

Abstract

BACKGROUND: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern. HYPOTHESIS: CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function. METHODS: Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF-CA), 150 congestive HF who were undergoing medical therapy (AFHF-Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF-CA). RESULTS: After 30 ± 6 months of follow up, 45.8% of patients in the AFHF-CA and 61.3% of patients in the AF-CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF-Med (P < .01). Hospitalization for HF was significantly lower in AFHF-CA than in AFHF-Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF-CA group, which was lower than 18% in the AFHF-Med group (P < .01). Significant improvements in heart function were shown in the AFHF-CA group compared to the AFHF-Med group, including LVEF (P < .01), LV end-diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF-CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia-related diseases. CONCLUSION: CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.