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Catheter Ablation for Patients with Afib and Heart Failure?

Catheter ablation improved left-ventricular function in patients with atrial fibrillation and heart failure in a small, nonrandomized study.

Catheter ablation has been very effective in patients with drug-refractory paroxysmal atrial fibrillation (AF), but most studied patients have had normal cardiac function. Researchers at a center in France have now assessed outcomes after catheter ablation in 58 consecutive patients with drug-refractory AF and heart failure (mean LV ejection fraction, 35%) and in 58 matched controls with AF, but without heart failure (mean LVEF, 66%).

Procedure-related complications included one stroke in the heart-failure group and pericardial tamponade in one patient in each group. About half of the patients in each group underwent a second ablation procedure because of early AF recurrence.

At a mean follow-up of 1 year, similar percentages of the two groups were in sinus rhythm (78% of heart-failure patients and 84% of controls), including patients who were not using antiarrhythmic drugs (69% and 71%, respectively). Both groups experienced significant mean improvements in quality of life and exercise capacity, and the heart-failure group also experienced significant mean benefits in heart-failure-related outcomes, including symptoms, LVEF (mean increase, 21%), and LV size. Improvements in LV function were significant whether or not pre-ablation rate control was adequate.

Comment: In this small study, catheter ablation of atrial fibrillation was highly effective in patients with or without heart failure. Heart-failure patients saw benefits in LV function, symptoms, and quality of life. The findings also challenge the notion that rate control and rhythm control are equivalent. Despite the promising results, we need data from large, randomized trials before catheter ablation can be considered for routine management of heart-failure patients with atrial fibrillation.

— Hugh Calkins, MD

Published in Journal Watch Cardiology January 14, 2005

Citation(s):

Hsu L-F et al. Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 2004 Dec 2; 351:2373-83.

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• Medline abstract (Free)

Stevenson WG and Stevenson LW. Atrial fibrillation and heart failure -- Five more years. N Engl J Med 2004 Dec 2; 351:2437-40.

• Original article (Subscription may be required)
• Medline abstract (Free)