Key result
Radiofrequency ablation linked to ~88% higher rate of sinus rhythm vs antiarrhythmics in AF and HF.
Why the study?
The study was conducted to compare the efficacy of radiofrequency ablation and antiarrhythmic therapy in patients with atrial fibrillation and chronic heart failure during 12-month observation.
Does radiofrequency ablation improve the maintenance of stable sinus rhythm compared to antiarrhythmic therapy in patients with atrial fibrillation and heart failure (LVEF <50%)?
Observational (n=130)
Does radiofrequency ablation improve the maintenance of stable sinus rhythm compared to antiarrhythmic therapy in patients with atrial fibrillation and heart failure (LVEF <50%)?
Absolute Event Rate: 75% vs 40%
Radiofrequency ablation is more effective than antiarrhythmic therapy in maintaining sinus rhythm and improving left ventricular ejection fraction in patients with atrial fibrillation and heart failure with LVEF <50%.
RFA was associated with higher sinus rhythm maintenance in AF-HF; hypothesis-generating and requires RCT confirmation before practice change.
Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40-49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.
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Seliutskii et al. (2020) conducted an observational in Atrial fibrillation and chronic heart failure (n=130). Radiofrequency ablation (RFA) vs. Antiarrhythmic therapy (AAT) was evaluated on Stable sinus rhythm at 12 months. Radiofrequency ablation maintained stable sinus rhythm at 12 months in 75% of patients with atrial fibrillation and heart failure, compared to 40% with antiarrhythmic therapy.
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