Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction.

BACKGROUND

Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern.

HYPOTHESIS: CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function.

METHODS

Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF-CA), 150 congestive HF who were undergoing medical therapy (AFHF-Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF-CA).

RESULTS

After 30 ± 6 months of follow up, 45.8% of patients in the AFHF-CA and 61.3% of patients in the AF-CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF-Med (P < .01). Hospitalization for HF was significantly lower in AFHF-CA than in AFHF-Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF-CA group, which was lower than 18% in the AFHF-Med group (P < .01). Significant improvements in heart function were shown in the AFHF-CA group compared to the AFHF-Med group, including LVEF (P < .01), LV end-diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF-CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia-related diseases.

CONCLUSION

CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.