Comparison of atrial arrhythmia recurrence after persistent atrial fibrillation ablation between patients with or without tachycardia‐induced cardiomyopathy

BACKGROUND: The presence of heart failure (HF) has been associated with poorer outcomes in patients undergoing catheter ablation (CA) for atrial fibrillation (AF). However, the effectiveness of CA amongst the subset of patients with tachycardia-induced cardiomyopathy (TIC) remains poorly defined. METHODS AND RESULTS: In a retrospective analysis we compared outcomes of first-time CA for persistent AF in a cohort of patients with previously diagnosed TIC (n = 45; age 58 ± 8 years; 91% male) to those with structurally normal hearts (non-TIC; n = 440; age 55 ± 9 years; 95% male). TIC was defined as an impaired ventricular function (left ventricular ejection function [LVEF] <50%), which was reversed after the treatment of HF. We compared atrial arrhythmias (AAs) recurrence after the CA in the TIC and non-TIC cohorts. In the TIC group, LVEF improved from 35.8% ± 8.1% to 57.5% ± 8.3% after treatment of HF. During 3.3 ± 1.5 years follow-up, AAs-free survival after CA was significantly higher in the TIC group as compared with the non-TIC group (69% vs 42%; P = .001), despite a comparable CA strategy between the two groups. In multivariable analysis, absence of HF with TIC, longer AF duration, and complex fractionated atrial electrogram ablation were independent predictors of arrhythmia recurrence (OR, 1.02; 95% CI, 1.01-1.03; P < .01; OR, 0.40; 95% CI, 0.20-0.79; P < .01 and OR, 2.29; 95%CI; 1.27-4.11; P < .01, respectively). In addition, the outcome after the last procedure was superior in the TIC cohort (89% vs 72%; P = .03) with fewer CA procedures as compared with the non-TIC cohort (1.3 ± 0.5 vs 1.5 ± 0.7; P = .01). CONCLUSIONS: Persistent patients with AF with TIC have a more favorable outcome after the CA as compared with those without.