Abstract 17250: Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Left Ventricular Dysfunction When Compare to Pharmacological Rate Control
Background: Catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF) is increasing in use, but long-term outcomes are controversial and sparse. This study compared the efficacy and safety of CA to medical treatment of AF in patients with HF.
Methods: Three groups of HF patients who underwent AF treatment were enrolled: 120 patients with congestive HF who were referred for first CA (AFHF-CA); 150 patients with congestive HF who were underwent medical rate control (AFHF-Medical); and 150 patients with normal heart function (AF-CA) who have matched age, gender and classification of atrial fibrillation with AFHF-CA. Patients were followed for 30-month, primary outcomes of AF recurrence, hospitalization, heart failure, stroke, death, and cardiac function were measured.
Results: Recruited patients’ average age was 61±8.7 years old, and 60% male. All classifications of AF were even distributed within the three treatment groups (p=0.57); with average AF duration of 80 ± 83 days (p=0.843); 206 (49%) persistent AF, 70 (17%) permanent AF, and 144 (34%) paroxysmal AF,. After 30±6 (mean±SD) months, 55/120 (45.8%) patients in AFHF-CA, 92/150 (61.3%) patients in AF-CA, were maintained in sinus rhythm after first procedure, compared with 4/150 (2.7%) patients in AFHF-Med (p<0.01). Although additional linear ablation was needed in AFHF-CA patients (86%), than AF-CA patients (71%) (p<0.01), the total durations of procedure, of fluoroscopy, and the server complications were comparable. The heart failure hospitalization was significantly lower in AFHF-CA (1.8±1.4 times), than that in AFHF-Med (3.1±1.0 times, P<0.01). Death occurred in 9/120 (7.5%) patients in AFHF-CA, which is lower than 27/150 (18%) in AFHF-Med (p<0.01). A significant improvement in left ventricle ejection fraction was detected from 41.9% to 53.8% (p<0.01), and NYHA classification from 2.7 ± 0.6 to 1.3 ± 0.5 (P<0.01) in AFHF-CA, but not in AFHF-Med (p=0.09)
Conclusion: CA for AF results in reduced hospitalizations and mortality, and improved heart function in HF patient when compared to medical treatment. Complications of CA are comparable between HF and non-HF patients with AF, although the success rate of ablation is lower in HF.
Author Disclosures: Y. Xi: None. X. Yin: None. L. Gao: None. D. Chang: None. Y. Yang: None. Y. Xia: None. J. Cheng: None.
- © 2016 by American Heart Association, Inc.