AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure .
AFCA provides long-term benefits on left ventricular function , significantly reducing the number of patients with severely impaired systolic function
BACKGROUND Catheter ablation of atrial fibrillation ( AFCA ) is an established therapeutic option for rhythm control in symptomatic patients .
Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small population s , and data concerning long-term outcome are limited .
We performed this meta- analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction , to evaluate predictors of recurrence and impact on left ventricular function .
Radiofrequency Catheter Ablation and Antiarrhythmic Drug Therapy: A Prospective, Randomized, 4-Year Follow-Up Trial: The APAF Study
Background — Information on comparative outcome between radiofrequency catheter ablation ( RFA ) and antiarrhythmic drugs ( AADs ) > 1 year after r and omization is important for clinical decision-making . Methods and Results — A total of 198 patients ( age , 56±10 years ) with paroxysmal atrial fibrillation were r and omly assigned to RFA ( 99 patients ) or to AADs ( 99 patients ) . We evaluated efficacy of RFA or AADs in a comparable 48-month follow-up period according to intention-to-treat analysis . Cardiac rhythm was assessed with daily transtelephonic transmissions . Quality of life was also analyzed . At 4 years , among the 99 patients first assigned to RFA , the procedure was repeated because of recurrent atrial fibrillation/atrial tachycardia in 27 patients ( 27.3 % ) . Among the 99 patients r and omly assigned to AADs , 87 ( 87.9 % ) crossed over to undergo RFA and 4 years after r and om assignment only 12 ( 12.1 % ) were in sinus rhythm with AAD alone without ablation . Despite the high level of crossovers , at 4 years the intention-to-treat analysis showed that 72.7 % of patients in the ablation arm and 56.5 % of those initially r and omly assigned to AADs were free of recurrent atrial fibrillation/atrial tachycardia ( P=0.017 ) . During the follow-up , 19.2 % of AAD patients progressed to persistent atrial fibrillation before switching to RFA . RFA significantly improved quality of life ( P<0.001 ) , whereas before crossing over to RFA , patients receiving AADs showed poorer quality of life . Except for new left atrial tachycardia , there were no serious complications caused by RFA . Conclusions — With follow-up extended to 4 years after r and omly assigned , ablation remains superior to antiarrhythmic drug in these patients with paroxysmal atrial fibrillation . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00340314
AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure .
AFCA provides long-term benefits on left ventricular function , significantly reducing the number of patients with severely impaired systolic function
BACKGROUND Catheter ablation of atrial fibrillation ( AFCA ) is an established therapeutic option for rhythm control in symptomatic patients .
Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small population s , and data concerning long-term outcome are limited .
We performed this meta- analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction , to evaluate predictors of recurrence and impact on left ventricular function .