Key result
Additional ablation beyond PVI fails to improve heart failure recovery despite longer procedure times.
Why the study?
The optimal catheter ablation strategy for patients with persistent atrial fibrillation and heart failure remains uncertain.
Does additional linear or electrogram-based ablation beyond pulmonary vein isolation improve heart failure recovery in patients with persistent atrial fibrillation?
Cohort (n=118)
Yes
Does additional linear or electrogram-based ablation beyond pulmonary vein isolation improve heart failure recovery in patients with persistent atrial fibrillation?
In patients with persistent atrial fibrillation and heart failure, adopting an extensive ablation strategy beyond pulmonary vein isolation increases procedural duration without yielding additional improvements in left ventricular systolic function.
Additional ablation beyond PVI was not associated with improved heart failure recovery yet extended procedure time; leaves open whether substrate modification benefits persist in randomized settings.
The optimal catheter ablation (CA) strategy for patients with persistent atrial fibrillation (PeAF) and heart failure (HF) remains uncertain. Between 2016 and 2020, 118 consecutive patients with PeAF and HF who underwent the CA procedure in two centers were retrospectively evaluated and divided into the pulmonary vein isolation (PVI)-only and PVI + additional ablation groups. Transthoracic echocardiography (TTE) was performed at baseline, one month, and 12 months after the CA procedure. The HF symptoms and left ventricular ejection fraction (LVEF) improvements were analyzed. Fifty-six patients underwent PVI only, and 62 patients received PVI with additional ablation. Compared with the baseline, a significant improvement in the LVEF and left atrial diameter postablation was observed in all patients. No significant HF improvement was detected in the PVI + additional ablation group than in the PVI-only group (74.2% vs. 71.4%, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>=</a:mo> <a:mn>0.736</a:mn> </a:math> ), but the procedure and ablation time were significantly longer (137.4 ± 7.5 vs. 123.1 ± 11.5 min, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.001</c:mn> </c:math> ). There was no significant difference in the change in TTE parameters and the number of rehospitalizations. For patients with PeAF and HF, CA appears to improve left ventricular function. Additional ablation does not improve outcomes and has a significantly longer procedure time. Trial registration number is as follows: ChiCTR2100053745 (Chinese Clinical Trial Registry; https://www.chictr.org.cn/index.aspx).
No takes yet. Share an insight, caveat, or question.
Ma et al. (2022) conducted a cohort in Persistent atrial fibrillation and heart failure (n=118). Pulmonary vein isolation (PVI) plus additional ablation vs. Pulmonary vein isolation (PVI) only was evaluated on Heart failure recovery (HF with recovered LVEF) (p=0.736). Additional ablation beyond pulmonary vein isolation did not significantly improve heart failure recovery compared to pulmonary vein isolation alone (74.2% vs 71.4%, p=0.736) but required significantly longer procedure times.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: