RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .
Contact force and force-time integral in atrial radiofrequency ablation predict transmurality of lesions.
AIMS During radiofrequency ( RF ) delivery , lesion volume is highly dependent on contact force ( CF ) . It has recently been shown that changes of bipolar electrogram ( EGM ) predict transmurality . We hypothesized that there is a correlation between CF and EGM criteria of transmural lesion ( TL ) during RF . METHODS AND RESULTS We prospect ively studied consecutive 512 RF applications from atrial fibrillation ablation procedures .  A force-sensing ablation catheter ( Tacticath ( ® ) , Endosense ) was used to continuously measure CF and force-time integral ( FTI ) during each RF application . Distal bipolar EGM was analysed before , during , and after each RF application . Depending on initial EGM morphology , transmurality of lesions was defined by : ( i ) disappearance of the positivity after RF when there was QR morphology , ( ii ) diminution > 75 % of the positivity when there was QRS morphology , or ( iii ) disappearance of the R ' positivity when there was RSR ' morphology . Electrogram criteria were vali date d by electrophysiologists blinded to force measurements . Force-time integral was higher in TL than in non-transmural lesions ( NTLs ) : 652 ± 248 vs. 212 ± 140 gs ( P < 0.001 ) . Mean CF per RF pulse was higher in TL than in NTL : 26.3 ± 12.5 vs. 11.3 ± 10.3 g ( P < 0.001 ) . The best cut-off to predict TL was an FTI ≥ 392 gs [ sensitivity 0.89 , specificity ( Sp ) 0.93 , positive predictive value ( PPV ) 0.98 , and negative predictive value 0.67 ] and a higher FTI ( > 700 gs ) warrants transmurality of RF atrial lesions ( 100 % Sp and PPV ) . CONCLUSION Contact force and FTI during RF are correlated with TL . During RF delivery , a target FTI > 392 gs can be used as an endpoint
RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .