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 .
Impact of Stepwise Ablation on the Biatrial Substrate in Patients With Persistent Atrial Fibrillation and Heart Failure
Background —Ablation of persistent atrial fibrillation can be challenging , often involving not only pulmonary vein isolation ( PVI ) but also additional linear lesions and ablation of complex fractionated electrograms ( CFE ) . We examined the impact of stepwise ablation on a human model of advanced atrial substrate of persistent atrial fibrillation in heart failure . Methods and Results —In 30 patients with persistent atrial fibrillation and left ventricular ejection fraction ⩽35 % , high-density CFE maps were recorded biatrially at baseline , in the left atrium ( LA ) after PVI and linear lesions ( roof and mitral isthmus ) , and biatrially after LA CFE ablation . Surface area of CFE ( mean cycle length ⩽120 ms ) remote to PVI and linear lesions , defined as CFE area , was reduced after PVI ( 18.3±12.03 to 10.2±7.1 cm2 ; P<0.001 ) and again after linear lesions ( 7.7±6.5 cm2 ; P=0.006 ) . Complete mitral isthmus block predicted greater CFE reduction ( P=0.02 ) . Right atrial CFE area was reduced by LA ablation , from 25.9±14.1 to 12.9±11.8 cm2 ( P<0.001 ) . Estimated 1-year arrhythmia-free survival was 72 % after a single procedure . Incomplete linear lesion block was an independent predictor of arrhythmia recurrence ( hazard ratio , 4.69 ; 95 % confidence interval , 1.05–21.06 ; P=0.04 ) . Conclusions —Remote LA CFE area was progressively reduced following PVI and linear lesions , and LA ablation reduced right atrial CFE area . Reduction of CFE area at sites remote from ablation would suggest either regression of the advanced atrial substrate or that these CFE were functional phenomena . Nevertheless , in an advanced atrial fibrillation substrate , linear lesions after PVI diminished the target area for CFE ablation , and complete lesions result ed in a favorable clinical outcome
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 .