Journal of cardiovascular electrophysiology · 2012
Long-term results of transcatheter atrial fibrillation ablation in patients with impaired left ventricular systolic function.
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Anselmino Matteo, Grossi Stefano, Scaglione Marco, Castagno Davide, Bianchi Francesca, Senatore Gaetano, Matta Mario, Casolati Dario, Ferraris Federico, Cristoforetti Yvonne, Negro Alessandro, Gaita Fiorenzo
Аннотация
INTRODUCTION: Long-term outcome of AF ablation in patients with impaired LVEF is unknown. The aim of this study is to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters over a long-term period following atrial fibrillation (AF) transcatheter ablation in patients with left ventricular ejection fraction (LVEF) <50%.
METHODS AND RESULTS: A total of 196 patients (87.2% males, age 60.5 ± 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.4-63.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow-up, 58 (29.6%) patients required repeated ablations. At the follow-up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty-three (47.2%) patients maintained antiarrhythmic drugs. During follow-up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.69-10.74, P = 0.002) of long-term clinical improvement (reduction in NYHA class ≥ 1 and relative increase in LVEF ≥ 10%).
CONCLUSIONS: Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long-term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement.
METHODS AND RESULTS: A total of 196 patients (87.2% males, age 60.5 ± 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.4-63.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow-up, 58 (29.6%) patients required repeated ablations. At the follow-up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty-three (47.2%) patients maintained antiarrhythmic drugs. During follow-up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.69-10.74, P = 0.002) of long-term clinical improvement (reduction in NYHA class ≥ 1 and relative increase in LVEF ≥ 10%).
CONCLUSIONS: Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long-term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement.