Abstract 13988: Pretreatment With Angiotensin-converting Enzyme Inhibitors Improves Ablation-outcome in Non-paroxysmal Atrial Fibrillation Patients With Low Left Ventricular Ejection Fraction
Background: Angiotensin-Converting Enzyme Inhibitors (ACE-I) are known to thwart the perpetuation of AF by facilitating the reversal of the structural and electrical remodeling of heart, the impact being greatest in patients with impaired left ventricular function. This study assessed the effect of upstream ACE-I therapy on ablation outcome in non-paroxysmal (persistent and long-standing persistent) AF (NPAF) patients with low left ventricular ejection fraction (LVEF).
Methods: Of the 1925 AF patients undergoing their first catheter ablation, 345 consecutive patients with low LVEF (<45%) were included in the study (NPAF, n= 270). Based on baseline ACE-I use, the NPAF population was divided into group 1 (on ACE-I therapy, n=143, 63±11 years, 78% male, BMI 32±8, LA size 4.7±0.8cm) and group 2 (no ACE-I, n=127, 63±10 years, 76% male, BMI 31±7, LA size 4.8±0.6cm). Treatment with ACE-I was started at least 3 months before ablation and continued through the duration of follow-up. Recurrence was assessed by event recordings, 7-day Holters and cardiology evaluations.
Results: Both groups in the NPAF cohort were similar in their baseline clinical characteristics. At 24±7 months follow-up after a single procedure, 109(76%) patients in group 1 and 81(64%) in group 2 (log-rank p = 0.015) were recurrence-free off-AAD (figure). After adjusting for baseline risks in multivariate analysis, ACE-I therapy was an independent predictor of long-term success [hazard ratio 1.7, 95% CI 1.1 to 2.73), p=0.026]. On the other hand, in patients with paroxysmal AF, ACE-I use was not found to be associated with ablation success (80% vs. 76% in on ACE-I and no ACE-I respectively, log-rank p=0.61).
Conclusion: In patients with reduced LVEF, pre-ablation use of ACE-I improves ablation outcome in NPAF patients only but not in the PAF population.
- © 2013 by American Heart Association, Inc.