Efficacy, Safety and Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction

Study Questions:

What are the outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) in patients with heart failure (HF) caused by diastolic dysfunction?

Methods:

This was a retrospective review of 74 patients (mean age 65 years) with AF (nonparoxysmal in 68%), an ejection fraction (EF) >50%, and ≥1 hospitalization HF, who underwent RFCA. Serial Holter monitors were performed during 12 months after RFCA. Echocardiograms were performed at baseline and 12 months of follow-up.

Results:

Including re-do procedures, the success rate of RFCA at a mean follow-up of 34 months was 45% in the absence of drug therapy and 74% with drug therapy. Long-standing persistent AF and hypertension were independently associated with AF recurrence. EF and indices of diastolic dysfunction significantly improved at 12 months of follow-up in patients who were free of AF and did not improve in patients with recurrent AF.

Conclusions:

The authors concluded that AF can be effectively treated by RFCA in patients with HF due to diastolic dysfunction.

Perspective:

Left ventricular diastolic dysfunction promotes left atrial dilatation and fibrosis, and these factors could explain the very modest efficacy of RFCA in the absence of drug therapy in this study. Unfortunately, because there was no comparison group of patients with preserved EF and no diastolic dysfunction, whether diastolic dysfunction is independently predictive of recurrent AF after RFCA is unknown. It is well documented that AF can cause systolic dysfunction and that maintenance of sinus rhythm is associated with an improvement in EF. A novel finding of this study is that maintenance of sinus rhythm also can improve diastolic dysfunction.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Cardiomegaly, Recurrence, Follow-Up Studies, Cardiomyopathies, Heart Failure, Dilatation, Electrocardiography, Catheter Ablation, Hypertension, Echocardiography


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