Abstract 13400: 5-year Outcomes After Catheter Ablation in Patients With Atrial Fibrillation and Left Ventricular Systolic Dysfunction
Backgroud. Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. The efficacy and safety amongst patients with left ventricular systolic dysfunction has been demonstrated often over a 1 year follow-up with improved cardiac function, heart failure status, and quality of life. However, long-term data are needed to understand if progression of cardiomyopathy may result in recurrence of arrhythmia and if the 1-year favorable results after ablation are maintained.
Methods: 3 groups with systolic heart failure (SHF) and 5 years of follow-up were matched 1:4:4 by age (±5 years) and sex. AF ablation patients receiving their first ablation (n=267), AF patients that did not receive an ablation (n=1068), and SHF patient without AF (n=1068). A patient was deemed as having SHF if they had both a clinical diagnosis(ICD-9 code 428.8*) and an ejection fraction(EF)<35%. Patients were followed for 5 year outcomes of AF recurrence, heart failure, stroke, death, and cardiac function.
Results: The average age of the population was 67±13 years and 78% male. The AF was paroxysmal in 25%, persistent in 34.7%, and longstanding persistent in 41%. At 5 years, 60.7% of patients had clinical recurrence of AF. Diabetes and a prior heart attack were the only significant predictors of long-term risk of AF recurrence after ablation. Long-term mortality rates were 27%, 55%, 50%, in the AF ablation, AF, and no AF groups, respectively (p<0.0001), with the lower rates attributed to lower cardiovascular mortality. Long-term, the AF Ablation and No AF groups had the lowest HF hospitalization rates (14%, 15%, vs. 21%, p<0.0001). At 5 years, stroke rates were similar amongst all groups.
Conclusion: Recurrence rates of AF in patients with SHF are common after an initial procedure at 5 years with an anticipated ongoing increase. In general, early improvement in cardiac function is not maintained at 5 years, but heart failure hospitalization is less after ablation. Overall survival at 5 years is highest in the AF ablation group, largely attributed to less cardiovascular deaths.
Author Disclosures: T.J. Bunch: None. H.T. May: None. T.L. Bair: None. V. Jacobs: None. B.G. Crandall: None. M. Cutler: None. J.P. Weiss: None. C. Mallendar: None. J.S. Osborn: None. J.L. Anderson: None. J.D. Day: None.
- © 2014 by American Heart Association, Inc.