Key result
Hybrid ablation linked to ~12% LVEF improvement in AF-related tachycardia-mediated cardiomyopathy.
Why the study?
The relationship between AF and heart failure with depressed EF is complex, and AF-related tachycardia-mediated cardiomyopathy (TMC) can worsen EF and clinical heart failure. The authors sought to determine whether hybrid ablation can safely restore sinus rhythm and delineate its effect on heart failure in these patients.
Does a hybrid ablation approach improve rhythm success and LVEF in patients with persistent AF and heart failure with reduced ejection fraction?
Observational (n=40)
No
Does a hybrid ablation approach improve rhythm success and LVEF in patients with persistent AF and heart failure with reduced ejection fraction?
Mean Difference: 12 (95% CI 7.85–16)
p-value: p=<.0001
Hybrid ablation in patients with persistent AF and tachycardia-mediated cardiomyopathy with reduced LVEF is safe and significantly improves LVEF, LA size, and NYHA class.
Supports hybrid ablation in AF cardiomyopathy; observational data leave open need for RCTs before practice change.
Objective The relationship between atrial fibrillation (AF) and heart failure with depressed ejection fraction (EF) is complex. AF-related tachycardia-mediated cardiomyopathy (TMC) can lead to worsening EF and clinical heart failure. We sought to determine whether a hybrid team ablation approach (HA) can be performed safely and restore normal sinus rhythm in patients with TMC and heart failure and to delineate the effect on heart failure. Methods We retrospectively analyzed patients with nonparoxysmal (ie, persistent and long-standing persistent) AF-related TMC with depressed left ventricular EF (LVEF ≤40%) and heart failure (New York Heart Association [NYHA] class ≥2) who underwent HA between 2013 and 2018 and had at least 1 year of follow-up. Pre-HA and post-HA echocardiograms were compared for LVEF and left atrial (LA) size. Rhythm success was defined as <30 seconds in AF/atrial flutter/atrial tachycardia without class I or III antiarrhythmic drugs. Results are expressed as mean ± SD and 95% confidence interval (CI) of the mean. Results Forty patients met the criteria for inclusion in our analysis. The mean patient age was 67 ± 9.4 years. The majority of patients had long-standing persistent AF (26 of 40; 65%), and the remainder had persistent AF (14 of 40; 35%). All patients had NYHA class II or worse heart failure (NYHA class II, 36 of 40 [90%]; NYHA class III, 4 of 40 [10%]). The mean time in AF pre-HA was 5.6 ± 6.7 years. All patients received both HA stages. No deaths or strokes occurred within 30 days. Three new permanent pacemakers (7.5%) were placed. Rhythm success was achieved in >60% of patients during a mean 3.5 ± 1.9 years of follow-up. LVEF improved significantly by 12.0% ± 12.5% (95% CI, 7.85%-16.0%; P < .0001), and mean LA size decreased significantly by 0.40 cm ± 0.85 cm (95% CI, 0.69-0.12 cm; P < .01), with a mean of 3.0 ± 1.5 years between pre-HA and post-HA echocardiography. NYHA class improved significantly after HA (mean pre-HA NYHA class, 2.1 ± 0.3 [95% CI, 2.0-2.2]; mean post-HA NYHA class, 1.5 ± 0.6 [95% CI, 1.3-1.7]; P < .0001). Conclusions Thoracoscopic HA of AF in selected patients with TMC heart failure is safe and can result in rhythm success with structural heart changes, including improvements in LVEF and LA size.
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Kiankhooy et al. (2022) conducted an observational in Atrial fibrillation-related tachycardia-mediated cardiomyopathy with depressed ejection fraction (n=40). Hybrid team ablation approach (HA) was evaluated on Improvement in left ventricular ejection fraction (LVEF) (MD 12.0%, 95% CI 7.85-16.0, p=<.0001). Hybrid ablation in patients with AF-related tachycardia-mediated cardiomyopathy significantly improved LVEF by 12.0% (95% CI 7.85-16.0%; P<0.0001) and decreased left atrial size.
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