Catheter ablation for persistent atrial fibrillation with left ventricular systolic dysfunction: Who is the best candidate?

Abstract

Background Tachycardia‐induced cardiomyopathy is poorly recognized pre‐ablation. It remains unclear of better patient selection and timing for catheter ablation in persistent atrial fibrillation (PerAF) with heart failure (HF). Methods Consecutive patients with PerAF and left ventricular ejection fraction (LVEF) <50% referred for AF ablation were retrospectively included. The impact of LV size, heart rate (HR), and LVEF pre‐ablation were analyzed for assessing LV systolic function recovery, defined as LVEF increase of ≥20% or to a value ≥55% after ablation. Results A total of 120 patients (2017–2020) were included. After 19 ±14 months post ablation, LVEF improvement was similar in patients with normal or dilated LV (18.3 ± 9.4% vs. 16.1 ± 10.8%, P = .25), rapid or controlled HR (19.5 ± 10% vs. 16.1 ± 10%, P = .09), but higher in HFrEF (HF with reduced EF) than HFmrEF (HF with midrange EF) (21.6 ± 10.3% vs. 14.9 ± 9.3%, P < .01). There was more LV systolic function recovery in those with normal to moderate LV dilation (80%, odds ratio [OR] 15.22, P < .01), HR ≥80 bpm (79%, OR 5.38, P < .01) and HFmrEF (80%, OR 4.03, P < .01). The overall AF freedom was similar between normal and dilated LV (59% vs. 62%, P = .95), rapid and controlled HR (67% vs. 56%, P = .18), and HFmrEF and HFrEF (65% vs. 50%, P = .19). Conclusion Catheter ablation is effective independent of LV dilation, rate control or HFrEF. Patients with normal to moderate LV dilation, resting HR ≥80 bpm and HFmrEF may be candidates for early PerAF ablation to achieve LVEF normalization.

Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance

“…These inconsistent results may be attributed to several factors, such as patient characteristics, HF etiology, follow-up duration, and ablation strategy. In addition, the improvement of prognosis in HF with impaired LVEF may be partially explained by the presence of tachycardia-induced cardiomyopathy, which is poorly recognized pre-ablation ( 36 ). However, it remains unclear of better patient selection and timing for RFCA in persistent AF with HF.…”

“…However, it remains unclear of better patient selection and timing for RFCA in persistent AF with HF. A recent study ( 36 ) indicated that patients with normal to moderate LV dilation, resting heart rate ≥ 80 bpm and HFmrEF may be candidates for early RFCA to achieve LVEF normalization.…”