Abstract 3404: Pulmonary Vein Isolation Results in Improved Ventricular Function: A Case-Control Study of Patients With Atrial Fibrillation, Heart Failure and Left Ventricular Dysfunction
Introduction: Small single-center studies suggest that catheter ablation of atrial fibrillation (AF) can improve ventricular function and reduce symptoms in patients (pts) with left ventricular (LV) dysfunction. However, ablation has not been compared to a pharmacologic strategy for AF, thus the genuine contribution of ablation is debatable.
Methods: We evaluated pts with AF and symptomatic LV dysfunction (EF <<26> 45%) referred for pulmonary vein isolation (PVI). We compared these pts to a matched (by age, gender, EF) cohort treated medically for AF.
Results: 15 pts (14 male, 56 ± 11 yrs, 10 [67%] paroxysmal AF ) with AF for 4 ± 3 yrs underwent PVI. Baseline EF was 37 ± 6%, NYHA class 2.0 ± 1.0 & heart rate (HR) 72 ± 23 bpm. 15 controls (13 male, 63 ± 14 yrs, 11 [73%] paroxysmal AF) with AF for 5 ± 4 yrs were treated medically (13 B-Blocker, 3 CCB, 1 Amiodarone) for AF. Baseline EF was 34 ± 11%, NYHA class 2.0 ± 0.7 & HR 74 ± 11 bpm. The groups were similar in all respects. During a follow-up (f/u) of 16 ± 13 mos after complete PVI, the EF improved (p=0.001) (Figure⇓), demonstrably in 12 (80%) & normalized in 8 (53%). NYHA class improved to 1.3 ± 0.5 (p=0.01). 4 pts had repeat PVI and 1 had ablation for atrial flutter; 11 (73%) were free from AF. In the medically treated group, after f/u of 16 ± 12 mos, no improvement in EF (36±12%) or NYHA class (1.8±0.7) was seen.
Conclusions: Compared to pharmacologic therapy, PVI significantly improved LV function and symptoms in pts with AF and symptomatic LV dysfunction. These provocative findings provide potent rationale for a randomized clinical trial comparing ablation to pharmacologic therapy and further suggests that AF often contributes to LV functional deterioration.