Key result
Sinus rhythm maintenance following transcatheter ablation in patients with LVEF <50% was an independent predictor of long-term clinical improvement (OR 4.26; 95% CI 1.69-10.74; P=0.002).
Why the study?
Does sinus rhythm maintenance following transcatheter ablation improve clinical and echocardiographic outcomes in patients with atrial fibrillation and LVEF <50%?
Cohort (n=196)
Does sinus rhythm maintenance following transcatheter ablation improve clinical and echocardiographic outcomes in patients with atrial fibrillation and LVEF <50%?
In patients with atrial fibrillation and impaired LVEF, transcatheter ablation has a high long-term recurrence rate, but successful sinus rhythm maintenance is associated with significant clinical and echocardiographic improvements.
Answers are grounded in this paper and cite their sources.
Supports sinus rhythm maintenance post-ablation in reduced LVEF; leaves open randomized comparison versus rate control.
INTRODUCTION: Long-term outcome of AF ablation in patients with impaired LVEF is unknown. The aim of this study is to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters over a long-term period following atrial fibrillation (AF) transcatheter ablation in patients with left ventricular ejection fraction (LVEF) <50%. METHODS AND RESULTS: A total of 196 patients (87.2% males, age 60.5 ± 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.4-63.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow-up, 58 (29.6%) patients required repeated ablations. At the follow-up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty-three (47.2%) patients maintained antiarrhythmic drugs. During follow-up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.69-10.74, P = 0.002) of long-term clinical improvement (reduction in NYHA class ≥ 1 and relative increase in LVEF ≥ 10%). CONCLUSIONS: Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long-term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement.
No takes yet. Share an insight, caveat, or question.
Anselmino et al. (2012) conducted a cohort in Atrial fibrillation with impaired left ventricular systolic function (n=196). Radiofrequency transcatheter ablation was evaluated on Long-term clinical improvement (reduction in NYHA class ≥ 1 and relative increase in LVEF ≥ 10%) (OR 4.26, 95% CI 1.69-10.74, p=0.002). Sinus rhythm maintenance following transcatheter ablation in patients with LVEF <50% was an independent predictor of long-term clinical improvement (OR 4.26; 95% CI 1.69-10.74; P=0.002).
Synapse has enriched 10 related papers. Consider them for comparative context: