What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent atrial fibrillation with left ventricular systolic dysfunction (n=97). Intervention: Radiofrequency catheter ablation vs. Direct current synchronized cardioversion (DCC) followed by amiodarone. Primary outcome: 12-month rate of sustained sinus rhythm (SR) (p=0.001).

March 28, 2017PLoS ONE6 citationsOpen Access

Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction

Q: What does this research mean for the field?

Catheter ablation yields a significantly higher 12-month sinus rhythm maintenance rate and better cardiac function improvement compared to direct current cardioversion in patients with persistent atrial fibrillation and left ventricular systolic dysfunction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

MWMaojing WangQingdao University SCShanglang CaiQingdao University WDWei DingAstraZeneca (United States)

Key Result

Catheter ablation yielded a significantly higher 12-month sinus rhythm maintenance rate (68.42%) compared to direct current cardioversion (35%) in patients with persistent atrial fibrillation and heart failure.

Study Design

Type

Cohort (n=97)

Multicenter

Structured PICO

Does radiofrequency catheter ablation improve 12-month sinus rhythm maintenance and cardiac function compared to direct current cardioversion in patients with persistent atrial fibrillation and left ventricular systolic dysfunction?

Population

97 consecutive adults (mean age 58.39, 52 males) with persistent atrial fibrillation and symptomatic heart failure (LVEF <50%). Exclusions: left atrial thrombus, severe heart valve disease, coronary heart disease treated with revascularization within 3 months, reversible causes of AF, alcohol use, and pregnancy.

Intervention

Radiofrequency catheter ablation (circumferential pulmonary vein isolation, PVI) with up to 3 procedures (mean 1.8 procedures), with warfarin anticoagulation.

Comparator

Direct current synchronized cardioversion (DCC) followed by amiodarone for sinus rhythm maintenance, with warfarin anticoagulation.

Outcome

12-month rate of sustained sinus rhythm (SR) and cardiac function (LVEF and NYHA classification).surrogate

In patients with persistent atrial fibrillation and left ventricular systolic dysfunction, catheter ablation significantly improves 12-month sinus rhythm maintenance and cardiac function compared to direct current cardioversion.

Main Result

Absolute Event Rate: 68.42% vs 35%

p-value: p=0.001

Limitations

Single center design
Relatively small sample size
Excluded patients at higher risk for complications associated with catheter ablation, such as those with longer duration of AF, older patients, and those with severe valvular disease and ischemic cardiomyopathy
Excluded patients at higher risk for complications (longer duration of AF, older patients, severe valvular disease, ischemic cardiomyopathy)

Abstract

OBJECTIVE: To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC) in patients with persistent atrial fibrillation (AF) and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation. METHODS: From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF) 20% or to over 55%) in 31 (54.39%) patients with worse baseline cardiac function and ventricular rate control. CONCLUSIONS: Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group.

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