Catheter ablation of atrial fibrillation in patients with heart failure with reduced ejection fraction: Real world experience from six European centers

Rui Providência; Carlo de Asmundis; K. R. Julian Chun; Gian‐Battista Chierchia; Pascal Defaye; Frédéric Anselme; António Creta; Pier D. Lambiase; Boris Schmidt; Shaojie Chen; Ross J. Hunter; Stéphane Combes; Shohreh Honarbakhsh; Nicolas Combes; Maria João Sousa; Zeynab Jebberi; Jean‐Paul Albenque; Serge Bovéda

doi:10.1111/jce.14027

Why the study?

Catheter ablation of AF impacts outcomes in patients with heart failure and reduced LVEF, but data assessing patients referred for ablation and the procedure's efficacy and safety compared with healthier patients were needed.

Is catheter ablation of atrial fibrillation as safe and effective in patients with LVEF ≤35% compared to those with LVEF >35%?

Structured PICO

Is catheter ablation of atrial fibrillation as safe and effective in patients with LVEF ≤35% compared to those with LVEF >35%?

P

Population

2083 consecutive patients undergoing catheter ablation of atrial fibrillation across six European centers, stratified by LVEF (≤35% vs >35%).

I

Intervention

Catheter ablation of atrial fibrillation in patients with LVEF ≤35%

C

Comparator

Catheter ablation of atrial fibrillation in patients with LVEF >35%

O

Outcome

Procedural safety (complication rate) and efficacy (atrial arrhythmia relapse post-blanking period in the first 12 months)

Catheter ablation of AF in patients with LVEF ≤35% is safe, and their higher arrhythmia relapse rates are driven by associated comorbidities rather than the reduced ejection fraction itself.

Implication

Supports ablation safety in low-LVEF AF; leaves open whether LVEF independently predicts relapse after adjustment.

Abstract

Introduction Catheter ablation of atrial fibrillation (AF) has been recently shown to have an impact on the outcome of patients with heart failure and reduced LV ejection fraction (LVEF). We aimed to assess patients with reduced LVEF referred to catheter ablation of AF, and the efficacy and safety of this procedure compared with healthier patients. Methods 2083 consecutive procedures of catheter ablation of AF in six centers were divided into two groups on the basis of LVEF (≤ vs >35%) and comparisons were performed regarding procedural safety and efficacy. Results Only 51 (2.4%) of patients had low LVEF. Complication rate was comparable: 8.0% vs 6.9% ( P = .760). Low LVEF patients are more frequently in persistent AF at the time of the procedure, have a higher degree of left atrial dilation, and higher CHA 2 DS 2 VASc score. The rate of atrial arrhythmia relapse post‐blanking period in the first 12 months was higher in the low LVEF group: 58.0% vs 37.6% ( P < .001). During a median follow‐up of 14 months (IQR 5‐24), after adjusting for all baseline differences, AF duration, paroxysmal AF, CHA 2 DS 2 VASc score, BMI, and indexed LA volume were independent predictors of relapse. LVEF and LVEF ≤ 35% were not identified as predictors of relapse. Conclusions Patients with reduced LVEF account for only a minority of patients undergoing catheter ablation of AF. However, ablation appears to be as safe as for the general population, and albeit the efficacy seems lower, this appears to be driven by other comorbidities or features, which are more frequent in this population.