Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

Abstract

Background: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs nonischemic heart failure. Methods:We conducted a retrospective, observational cohort study of patients with HF who underwent AF ablation. Outcomes were compared based on HF etiology and included in-hospital events, symptoms (Mayo AF Symptom Inventory [MAFSI]), and functional status (New York Heart Association class) and freedom from atrial arrhythmias at 12 months.Results: Among 242 patients (n = 70 [29%] ischemic, n = 172 [71%] nonischemic), patients with nonischemic cardiomyopathy were younger (mean age 64 ± 11.5 vs 69 ± 9.1, P = .002), more often female (36% vs 17%, P = .004), and had higher mean leftventricular ejection fraction (47% vs 42%, P = .0007). There were no significant differences in periprocedural characteristics, including mean procedure time (243 ± 74.2 vs 259 ± 81.8 minutes, P = .1) and nonleft atrial ablation (17% vs 20%, P = .6). All-cause adverse events were similar in each group (15% vs 17%, P = .7). NYHA and MAFSI scores improved significantly at follow-up and did not differ according to HF etiology (P = .5; P = .10-1.00 after Bonferroni correction). There were no significant differences in freedom from recurrent atrial arrhythmia at 12-months between ischemic (74%) and nonischemic patients (78%): adjusted RR 0.63, 95% confidence interval 0.33-1.19. Conclusions:Catheter ablation in patients with AF and concomitant heart failure leads to significant improvements in functional and symptom status without significant differences between patients with ischemic vs nonischemic HF etiology. | 85BLACK-MAIER Et AL.

Atrial Fibrillation and Mortality: Prognostic Factors and Direction of Prevention

“…В сравнительном исследовании Е. Black-Maier и соавт. [34] результатов КА у пациентов с ФП и СН ишемической и неишемической этиологии наблюдались статистически значимые улучшения функциональной активности, уменьшение функционального класса по NYHA и увеличение периода, в течение которого отсутствовала ФП в обеих группах, без статистически значимых различий между ними [26]. Однако в исследовании S. Long и соавт.…”

“…Рассмотренные исследования свидетельствуют в пользу внедрения КА как безопасного и эффективного метода контроля ритма для большой группы пациентов с ФП и СН [10,34]. Имея данные о проаритмогенном эффекте ААП и их вероятном закреплении субстрата ФП, можно предположить, что у пациентов с ФП раннее назначение процедуры КА или ее применение как терапии первой линии может быть более эффективно в восстановлении синусового ритма и предотвращении возникновения или прогрессирования СН, соответственно снижая все риски, связанные с ФП и СН.…”

Editorial to “effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology”

“…In this context, Black‐Maier E et al conducted a retrospective observational study aiming to assess the comparative efficacy of AF ablation in patients with ischemic versus non‐ischemic HF . The outcomes of this analysis were as follows: in‐hospital events, symptoms (assessed by the Mayo AF Symptom Inventory [MAFSI]), functional status (assessed by New York Heart Association [NYHA] class), and freedom from atrial arrhythmias at 12‐month follow‐up.…”