Different catheter ablation strategies for atrial fibrillation in patients with chronic heart failure

Objective. To evaluate the efficacy of different catheter ablation strategies for atrial fibrillation (AF) in patients with chronic heart failure (CHF). Material and methods. Forty (n=40) patients with systolic dysfunction (ejection fraction <50%) and AF underwent catheter ablation: 15 patients underwent cryoballoon ablation (CBA), and 25 patients underwent radiofrequency ablation (RFA) of pulmonary veins (PV). Depending on ablation technique, all participants were divided into the groups. Patients with persistent AF from the CBA group underwent cryoballoon posterior wall isolation (PWI) of the left atrium (LA) in addition to isolation of PV. All procedures were performed without fluoroscopy except for PWI. At baseline and after 12 postoperative months, clinical course of CHF was assessed (Minnesota Questionnaire, 6-minute walk test (6-MWT) and New York Heart Association (NYHA) functional class). Transthoracic echocardiography parameters (TTE) were also assessed at baseline and after 12 months. Results. No documented AF recurrences were registered in 15 (73%) patients from the CBA group and 17 (68%) patients from the RFA group (p=0.78). After 12 months, LV EF significantly increased in both groups (from 45 [35; 47] to 55 [49; 60]% in the CBA group (p=0.001) and from 45 [37; 47] to 60 [54; 60]% in the RFA group, p=0.0001). Volumetric and linear parameters of the left atrium and pulmonary artery systolic pressure significantly decreased. Annual follow-up revealed clinical and laboratory signs of CHF improvement with significant decrease in functional class of CHF, increase in 6-MWT distance, decrease of serum NT-proBNP and higher quality of life. No significant between-group differences were found after 12 months for all these parameters. One complication occurred in each group (p=0.89). Conclusion. CBA is an equally effective procedure to RFA in patients with AF and CHF. Both methods have a good effect on the course of CHF, increase left ventricular systolic function and contribute to reverse cardiac remodeling.