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 .
Early safety and efficacy of percutaneous left atrial appendage suture ligation: results from the U.S. transcatheter LAA ligation consortium.
BACKGROUND Transcatheter left atrial appendage ( LAA ) ligation may represent an alternative to oral anticoagulation for stroke prevention in atrial fibrillation . OBJECTIVES This study sought to assess the early safety and efficacy of transcatheter ligation of the LAA for stroke prevention in atrial fibrillation . METHODS This was a retrospective , multicenter study of consecutive patients undergoing LAA ligation with the Lariat device at 8 U.S. sites . The primary endpoint was procedural success , defined as device success ( suture deployment and < 5 mm leak by post-procedure transesophageal echocardiography ) , and no major complication at discharge ( death , myocardial infa rct ion , stroke , Bleeding Academic Research Consortium bleeding type 3 or greater , or cardiac surgery ) . Post-discharge management was per operator discretion . RESULTS A total of 154 patients were enrolled .  Median CHADS2 score ( congestive heart failure , hypertension , age ≥ 75 years , diabetes mellitus , prior stroke , transient ischemic attack , or thromboembolism [ doubled ] ) was 3 ( interquartile range : 2 to 4 ) . Device success was 94 % , and procedural success was 86 % . A major complication occurred in 15 patients ( 9.7 % ) . There were 14 major bleeds ( 9.1 % ) , driven by the need for transfusion ( 4.5 % ) . Significant pericardial effusion occurred in 16 patients ( 10.4 % ) . Follow-up was available in 134 patients at a median of 112 days ( interquartile range : 50 to 270 days ) : Death , myocardial infa rct ion , or stroke occurred in 4 patients ( 2.9 % ) . Among 63 patients with acute closure and transesophageal echocardiography follow-up , there were 3 thrombi ( 4.8 % ) and 13 ( 20 % ) with residual leak . CONCLUSIONS In this initial multicenter experience of LAA ligation with the Lariat device , the rate of acute closure was high , but procedural success was limited by bleeding . A prospect i ve r and omized trial is required to adequately define clinical efficacy , optimal post-procedure medical therapy , and the effect of operator experience on procedural safety
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 .