Catheter ablation may be an effective therapy in AF patients with left ventricular systolic impairment , and can be associated with improvements in left ventricular function , quality of life , exercise capacity , and modest rates of serious adverse events
INTRODUCTION Catheter ablation of atrial fibrillation ( AF ) is an established rhythm control strategy ; however , the impact of co-existing LV systolic dysfunction ( LVSD ) on ablation success is less well understood .
This systematic review compiles the outcomes of catheter ablation of atrial fibrillation in patients with LVSD .
Electrical Remodeling of the Atria in Congestive Heart Failure: Electrophysiological and Electroanatomic Mapping in Humans
Background —Atrial  fibrillation ( AF ) frequently complicates congestive heart failure ( CHF ) . However , the electrophysiological substrate for AF in humans with CHF remains unknown . We evaluated the electrophysiological and electroanatomic characteristics of the atria in patients with CHF . Methods and Results —Twenty-one patients ( aged 53.7±13.6 years ) with symptomatic CHF ( left ventricular ejection fraction 25.5±6.0 % ) and 21 age-matched controls were studied . The following were evaluated : effective refractory periods ( ERPs ) from the high and low lateral right atrium ( LRA ) , high septal right atrium , and distal coronary sinus ( CS ) ; conduction time along the CS and LRA ; corrected sinus node recovery times ; P-wave duration ; and conduction at the crista terminalis . In a subset , electroanatomic mapping was performed to determine atrial activation , regional conduction velocity , double potentials , fractionated electrograms , regional voltage , and areas of electrical silence .  Patients with CHF demonstrated an increase in atrial ERP with no change in the heterogeneity of refractoriness , an increase of atrial conduction time along the LRA and the CS , prolongation of the P-wave duration and corrected sinus node recovery times , and greater number and duration of double potentials along the crista terminalis . Electroanatomic mapping demonstrated regional conduction slowing with a greater number of electrograms with fractionation or double potentials , associated with areas of low voltage and electrical silence ( scar ) . Patients with CHF demonstrated an increased propensity for AF with single extrastimuli , and induced AF was more often sustained . Conclusions —Atrial remodeling due to CHF is characterized by structural changes , abnormalities of conduction , sinus node dysfunction , and increased refractoriness . These abnormalities may be responsible in part for the increased propensity for AF in CHF
Catheter ablation may be an effective therapy in AF patients with left ventricular systolic impairment , and can be associated with improvements in left ventricular function , quality of life , exercise capacity , and modest rates of serious adverse events
INTRODUCTION Catheter ablation of atrial fibrillation ( AF ) is an established rhythm control strategy ; however , the impact of co-existing LV systolic dysfunction ( LVSD ) on ablation success is less well understood .
This systematic review compiles the outcomes of catheter ablation of atrial fibrillation in patients with LVSD .