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Catheter ablation of atrial fibrillation in patients with heart failure with reduced ejection fraction: Real world experience from 6 European centers

Providência, R; de Asmundis, C; Chun, J; Chierchia, G; Defaye, P; Anselme, F; Creta, A; ... Boveda, S; + view all (2019) Catheter ablation of atrial fibrillation in patients with heart failure with reduced ejection fraction: Real world experience from 6 European centers. Journal of Cardiovascular Electrophysiology , 30 (8) pp. 1270-1277. 10.1111/jce.14027. Green open access

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Abstract

INTRODUCTION: Catheter ablation of atrial fibrillation (AF) has been recently shown to have an impact on the outcome of patients with heart failure and reduced LV ejection fraction (LVEF). We aimed to assess patients with reduced LVEF referred to catheter ablation of AF, and the efficacy and safety of this procedure compared to healthier patients. METHODS: 2,083 consecutive procedures of catheter ablation of AF in 6 centers were divided in two groups based on LVEF (≤ vs. >35%) and comparisons were performed regarding procedural safety and efficacy. RESULTS: Only 51 (2.4%) of patients had low LVEF. Complication rate was comparable: 8.0% vs. 6.9% (P=0.760). Low LVEF patients are more frequently in persistent AF at the time of the procedure, have higher degree of left atrial dilation, and higher CHA2 DS2 VASc score. The rate of atrial arrhythmia relapse post-blanking period in the first 12 months was higher in the low LVEF group: 58.0% vs. 37.6% (P<0.001). During a median follow-up of 14 months (IQR 5-24), after adjusting for all baseline differences, AF duration, paroxysmal AF, CHA2 DS2 VASc score, BMI, and indexed LA volume were independent predictors of relapse. LVEF and LVEF≤35% were not identified as predictors of relapse. CONCLUSIONS: Patients with reduced LVEF account for only a minority of patients undergoing catheter ablation of AF. However, ablation appears to be as safe as for the general population, and albeit the efficacy seems lower, this appears to be driven by other comorbidities or features, which are more frequent in this population. This article is protected by copyright. All rights reserved.

Type: Article
Title: Catheter ablation of atrial fibrillation in patients with heart failure with reduced ejection fraction: Real world experience from 6 European centers
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.14027
Publisher version: https://doi.org/10.1111/jce.14027
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: LV ejection fraction, heart failure, mortality, sinus rhythm, vascular complications
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10076285
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