Six‐Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function

Abstract

Single-procedure success rates after PVI during 6 years of follow-up were low. In patients with single- or multiple-procedure ablation success, a higher improvement of LVEF was observed.

Catheter Ablation of Atrial Fibrillation in Chronic Heart Failure: A Contemporary Review

“…In general, the advanced structural and electrical atrial remodeling characteristic of these patients seems not to impact the final outcome of ablation, although it is frequently associated with the need for multiple procedures to maintain SR. 4 Concerning long-term follow-up, six studies focused on late outcome (i.e., of more than two years) following AF ablation, finding that despite lower efficacy after a single procedure (around 30-50%), the overall efficacy including repeated procedures was ultimately higher, at 70% to 80%. 21,26,28,[31][32][33] Interestingly, despite more procedures being performed per patient in these cases, the complication rates were similar to those in previous studies, mainly due to the use of improved technologies and procedural amendments, such as performing ablation under uninterrupted anticoagulation.…”

“…Several studies reported on improvement in LV systolic function, quality of life, exercise tolerance and functional class, mitral regurgitation, reduction of heart failure hospitalizations and incidence of stroke. [16][17][18][19][22][23][24][25][26][27][28][31][32][33] Two studies selectively focused on patients with TCM, specifically 113 individuals. AF ablation efficacy at followup (six to 18 months) was 74%, and mean LVEF significantly improved from 35% or 40% to 54%, suggesting that TCM did not increase the risk of AF recurrence.…”

Efficacy and Safety of Cryoballoon Ablation in Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction ― A Multicenter Study ―

“…20,21 As previously reported for RF-based PVI in HF, patients with reduced LVEF without evidence of structural heart disease seem to benefit most from catheter ablation with regards to freedom of AF and improvement of LVEF. 22 Especially, in patients with baseline LVEF <35%, the clinical implication of LVEF improvement to >35% gains further importance because ICD implantation as primary prevention might therefore no longer be necessary. 10,11 As a consequence of the findings of the "Fire And Ice" trial, latest AF guidelines state that PVI should be performed using either RF or CB catheters.…”

Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach

“…Although CA is a well-established and effective treatment option 13,14 for patients with symptomatic AF, it is associated with a significant risk of peri-and postprocedural complications. 1,14 The increased risk of thromboembolic complications is likely related to the exacerbation of baseline prothrombotic state by catheters in the left atrium, endothelial denudation, and tissue inflammation as a result of ablation. 15 Effective anticoagulation is key to prevent the thromboembolic risk associated with AF ablation while balancing the associated bleeding risks.…”