January 1, 2014Arquivos Brasileiros de Cardiologia32 citationsOpen Access

Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

TLTasso J. Lobo CPCarlos Thiene Cunha Pachón JPJosé Carlos Pachón

Structured PICO

Does stepwise radiofrequency ablation improve clinical and echocardiographic outcomes in patients with atrial fibrillation and ventricular systolic dysfunction?

Population

31 patients (25 men, 6 women), mean age 59.8 ± 10.6 years, with ventricular systolic dysfunction (ejection fraction ≤50%) and atrial fibrillation refractory to clinical treatment.

Intervention

Stepwise radiofrequency catheter ablation in a single session, including pulmonary vein isolation, ablation of atrial fibrillation nests, and ablation of residual background tachycardia.

Outcome

Clinical (NYHA functional class) and echocardiographic (ejection fraction, left atrial diameter) changes before and after ablation.surrogate

Stepwise radiofrequency ablation of atrial fibrillation in patients with systolic dysfunction is safe and associated with significant improvements in ejection fraction and functional class.

Limitations

Retrospective study design
Different criteria for drug treatment of heart failure
Asymptomatic and undiagnosed AF might occur during follow-up
Variation in time of post-ablation control echocardiography
Use of NYHA functional classification (qualitative variable)

Abstract

BACKGROUND: Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. OBJECTIVE: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. METHODS: Patients with ventricular systolic dysfunction ejection fraction (EF) <50% and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. RESULTS: 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8 ± 10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3 ± 17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23 ± 0.56; postablation: 1.13 ± 0.35; p < 0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68% ± 6.02%, post: 59% ± 13.2%, p = 0.0005) and a significant left atrial diameter reduction (pre: 46.61 ± 7.3 mm; post: 43.59 ± 6.6 mm; p = 0.026). No major complications occurred. CONCLUSION: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

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