Abstract 15856: Evaluation of Hybrid Approach for Rythm Control in Patients with Persistent Atrial Fibrillation, Cardiomyopathy, and Heart Failure
Background: Rate and rhythm control options have been reported to be equally effective in patients with atrial fibrillation (AF) including those with congestive heart failure (CHF). We report a single centre experience of rhythm control in patients with persistent AF, Cardiomyopathy (CMY) (EF<40%) refered for management of Heart Failure (CHF)
Methods: In this single centre study, we analyzed data from 145 patients with CMY (mean EF=27±9%), and persistent AF, referred over 7 years for management of CHF (NYHA: 2.74). We employed a hybrid approach (see Fig. 1) including Right Atrial foci and Isthmus ablation, drug and device therapy as needed for achieving rhythm control. The mean age was 67.5±16.6 years (males=110, females=35), 56% with ischemic heart disease (IHD), 17% with diabetes. 80% were receiving ARB/ACE, 62% on diuretics, and 84% on beta blocker.
Results: After mean follow up of 20±17 months, 76% of patients were in sinus rhythm. Average EF improved to 37±12 %( P<.05) and function class improved to 2.2. EF improvement was significantly higher in patients who remained in NSR (10 ± 11%) than those in AF (4±9%) (P<.05). 90% of non-IHD patients were in NSR with a higher EF (41±10%) than IHD patients (33±13%)(P<.05) 64% of which were in NSR.
Conclusions: In heart failure patients with persistent AF and CMY, a rhythm control strategy including a hybrid approach achieved NSR in 76%. NSR was associated with higher EF in IHD and Non-IHD patients. Non-IHD patients showed the greatest benefit. A hybrid approach including right side ablation may be considered in CHF patients with AF and CMY.
- © 2012 by American Heart Association, Inc.