Key result
Maintenance of sinus rhythm after catheter ablation in patients with reduced LVEF independently predicted long-term clinical improvement (OR 4.56; 95% CI 1.69-9.94; P=0.002).
Why the study?
This study was conducted to evaluate long-term results, sinus rhythm maintenance, clinical status, and echocardiographic parameters following catheter ablation of AF in patients with reduced LVEF.
Does maintenance of sinus rhythm after catheter ablation improve clinical status and echocardiographic parameters in patients with atrial fibrillation and reduced LVEF?
Cohort (n=112)
Does maintenance of sinus rhythm after catheter ablation improve clinical status and echocardiographic parameters in patients with atrial fibrillation and reduced LVEF?
In patients with atrial fibrillation and reduced LVEF, maintaining sinus rhythm after catheter ablation is strongly associated with long-term improvements in NYHA functional class and LVEF.
May support AF ablation benefit in HFrEF; leaves open need for randomized confirmation of long-term outcomes.
Objective This study aims to evaluate long-term results after catheter ablation of atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF) and to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters in the long-term follow-up period. Material and methods The study included 112 patients (75.5% men, age 59.5±11.5 years) with LV EF <50% underwent radiofrequency catheter ablation for paroxysmal (24%) or persistent (76%) AF. Patients after ablation were followed up for 38.4 (17.7–54.5) months for AF recurrence, functional class, and echocardiographic parameters. Results All patients underwent complete antral isolation of the pulmonary veins, and 95 (84.8%) underwent additional linear ablations in the left atrium. During the follow-up period, 48 (42.8%) patients experienced arrhythmia recurrence in the form of AF, atrial flutter, or ectopic atrial tachycardia. Repeated ablations were required in 35 (31.2%) patients. After ablation, antiarrhythmic drugs continued to be taken in 75 (66.9%) patients. During follow-up, NYHA class improved at least one class more often among patients in stable sinus rhythm than patients with recurrences (77.5% vs 51.2%, p=0.003). LV EF improved in patients maintaining sinus rhythm (36.6% vs 19.4%; P=0.016), and the degree of mitral regurgitation was significantly reduced (P<0.001) only in these patients. On multivariate analysis, maintenance of sinus rhythm was an independent predictor (odds ratio 4.56, 95% CI 1.69–9.94, P=0.002) of long-term clinical improvement (reduction in NYHA class ≥1 and relative improvement in LVEF ≥10%). Conclusions In patients with reduced LV EF, maintenance of sinus rhythm after ablation is associated with more significant clinical improvement. In the long-term period, the effectiveness of AF ablation in patients with reduced LVEF, as an improvement in the NYHA class and an increase in LVEF, is affected by a high rate of long-term recurrences.
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Baimbetov et al. (2022) conducted a cohort in Atrial fibrillation with reduced left ventricular ejection fraction (n=112). Maintenance of sinus rhythm vs. Arrhythmia recurrence was evaluated on Long-term clinical improvement (reduction in NYHA class ≥1 and relative improvement in LVEF ≥10%) (OR 4.56, 95% CI 1.69-9.94, p=0.002). Maintenance of sinus rhythm after catheter ablation in patients with reduced LVEF independently predicted long-term clinical improvement (OR 4.56; 95% CI 1.69-9.94; P=0.002).
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