Abstract 15689: Reversal of Left Ventricular Systolic Dysfunction Following Standalone Pulmonary Vein Isolation of Atrial Fibrillation in Patients With Heart Failure With Reduced Ejection Fraction
Background: Congestive heart failure and atrial fibrillation (AF) often co-exist. Restoration of sinus rhythm (SR) has shown to be beneficial in heart failure with reduced ejection fraction (HFrEF). However there is no consensus on the type of ablation to be performed. We sought to see the effect of standalone pulmonary vein isolation (PVI) in this population.
Methods: This is a retrospective study of standalone PVI, performed by a single operator. No other additional ablations were performed. LVEF was determined before PVI and again at 3 to 6 months at follow up. 24 hours holter monitor was performed at 3, 6 and 12 months after PVI and also with symptoms following PVI. Any AF after 3 months of blanking period is considered as recurrence. For symptomatic recurrence, repeat PVI was offered.
Results: PVI was performed in 420 consecutive patients. Of these, 67 (16%) patients with long standing AF had low ejection fraction (<40%) with a mean of 32.5 ± 8%. Average LA size was 5.7 ± 0.9 and NYHA class was 2.2 ± 0.4. Out of 67 patients, 42 (63%) patients remained in sinus rhythm at follow up (mean 23.9 + 16 months). Their mean LVEF improved from 32.3 ± 8 to 49 ± 8%. In these patients, 15 redo PVIs were performed to maintain sinus rhythm. Out of the remaining 25 patients who remained in AF, post PVI LVEF 35.2± 10 was not different from pre PVI LVEF. Five redo PVIs were attempted in these 25 patients. On multivariate logistic regression analysis, absence of hypertension and coronary artery disease predicted sinus rhythm at follow up.
Conclusions: Sixty three (63) % of AF patients with HFrEF remained in SR after standalone PVI. Standalone PVI (which may reduce procedure time) was effective in improving LVEF and NYHA in these patients with longstanding AF and HFrEF. Standalone PVI may be utilized to control rhythm even in this sicker population.
- © 2013 by American Heart Association, Inc.