Radiofrequency Ablation for Persistent Atrial Fibrillation in Patients With Advanced Heart Failure and Severe Left Ventricular Systolic Dysfunction: A Randomised Controlled Trial

Study Questions:

Does radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) improve left ventricular ejection fraction (LVEF) in patients with heart failure (HF)?

Methods:

Thirty-eight patients (mean age 63 years) with HF, LVEF <35% (mean 18%), and persistent AF were randomized to RFCA (n = 20) or a rate-control strategy (n = 18). A stepwise ablation strategy was used and patients were treated with amiodarone for 3 months. LVEF was measured by magnetic resonance imaging (MRI) and radionuclide ventriculography (RNV) at baseline and 6 months of follow-up. The primary endpoint was change in LVEF by MRI.

Results:

Twenty-seven procedures were performed in the 20 patients in the RFCA group and 50% were in sinus rhythm at 6 months of follow-up. There was no significant difference in the change in LVEF by MRI between the RFCA group (+4.5%) and the rate-control group (+2.8%). However, improvement in LVEF by RNV was significantly greater in the RFCA group (+8.2%) than in the rate-control group (+1.4%). The LVEF by MRI did improve to a significantly greater degree in patients who were in sinus rhythm at 6 months (+10.4%) than in patients who were in AF (+1.5%).

Conclusions:

The authors concluded that RFCA of persistent AF improves LVEF by RNV (but not by MRI) to a greater degree than a rate-control strategy in patients with advanced HF.

Perspective:

The discrepancy in LVEF by MRI versus RNV indicates a measurement error in one of the two techniques. However, even with MRI, LVEF did improve significantly in patients who were in sinus rhythm, indicating that sinus rhythm is a worthwhile goal in patients with a low LVEF.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Follow-Up Studies, Radionuclide Ventriculography, Cardiomyopathies, Heart Failure, Catheter Ablation, Magnetic Resonance Imaging


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