Long-Term Follow-Up After Atrial Fibrillation Ablation in Patients With Impaired Left Ventricular Systolic Function: The Importance of Rhythm and Rate Control
What are the outcomes after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) in patients with a left ventricular (LV) dysfunction?
Sixty-nine patients (mean age 69 years) with an ejection fraction (EF) ≤40% (mean 31%) underwent RFCA of AF (persistent in 64%) and were serially re-evaluated with 7-day Holter monitors and echocardiograms during 24 months of follow-up. These patients were compared retrospectively to a control group of age- and gender-matched patients without LV dysfunction.
After a mean of 1.6 procedures/patient, 65% of patients were free of AF at a mean follow-up of 28 months. In patients with recurrent AF, the EF improved by 8% at 6 months of follow-up then remained stable. In patients who remained in sinus rhythm, the EF improved by 15% at 6 months post-ablation and continued to improve, reaching a mean of 53% at 28 months. A higher baseline heart rate (but not rhythm status) was an independent predictor of EF improvement at 6 months. Sinus rhythm (but not heart rate) was an independent predictor of improvement in EF at 12-24 months post-ablation. Efficacy and complication rate did not differ between the study patients and the control group.
The authors concluded that sinus rhythm is associated with a long-term improvement in EF after RFCA of AF in patients with LV dysfunction.
This study demonstrates that there is a component of AF-induced cardiomyopathy that is independent of an uncontrolled rate. The results of this study strengthen the case for catheter ablation of AF in patients with LV dysfunction even when there is good heart rate control.
Keywords: Heart Atria, Cardiomyopathies, Atrial Fibrillation, Heart Rate, Catheter Ablation, Ventricular Dysfunction, Left, Pyrazines
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