Journal Article

Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication

Agustín Bortone, Serge Boveda, Jean-Luc Pasquié, Pénélope Pujadas-Berthault, Eloi Marijon, Anthony Appetiti and Jean-Paul Albenque

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 11, issue 8, pages 1018-1023
Published in print August 2009 | ISSN: 1099-5129
Published online June 2009 | e-ISSN: 1532-2092 | DOI: https://dx.doi.org/10.1093/europace/eup167
Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication

Show Summary Details

Preview

Aims

In the setting of congestive heart failure (CHF), atrial fibrillation (AF) ablation can improve clinical status and the left ventricular ejection fraction (LVEF) value. However, the impact of AF ablation on the implantable cardioverter defibrillator (ICD) indication has never been specifically addressed.

Methods and results

Study subject were six CHF (mean age 61.1 ± 6.9 years, mean LVEF 25.8 ± 7.3%) patients refractory to conventional medical treatment with long-lasting AF unresponsive to external cardioversion. Five patients had an idiopathic dilated cardiomyopathy (DCM) and one had an ischaemic cardiomyopathy (ICM). Their New York Heart Association (NYHA) class was III–IV. Two patients had renal insufficiency. No patient had left ventricular delay. All patients underwent AF ablation. LVEF and NYHA class were dramatically improved in the five DCM patients. New York Heart Association class, but not the LVEF, was improved in the ICM patient. A redo ablative procedure was undertaken in four of five DCM patients and in the ICM patient due to arrhythmia recurrence. Left ventricular ejection fraction and NYHA were improved again in the DCM patients (56 ± 4.4%, I–II, respectively) and led to ICD indication preclusion. The LVEF remained low in the ICM patient (30%) and led to ICD insertion. Sinus rhythm has been stable during the 18.1 ± 5.7 months follow-up period.

Conclusion

Atrial fibrillation ablation in CHF patients can improve both the clinical status of patients and their LVEF, especially among those affected by DCM. The LVEF improvement has the potential to preclude the indication for a primary prevention ICD insertion.

Keywords: Long-lasting atrial fibrillation; Catheter ablation; Congestive heart failure; Implantable; Cardioverter-defibrillator; Left ventricular ejection fraction; Outcome

Journal Article.  3214 words.  Illustrated.

Subjects: Cardiovascular Medicine

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.