Long-term outcome of catheter ablation for atrial fibrillation in patients with severe left atrial enlargement and reduced left ventricular ejection fraction
- Resource Type
- Authors
- Maria Luce Caputo; Giulio Conte; Tardu Özkartal; Roberto Rordorf; Enrico Baldi; Jolie Bruno; Andrea Demarchi; Sabatino D'Amore; Laura Neumann; Alessandro Vicentini; Antonio Sanzo; Angelo Auricchio; Simone Savastano; Flavia Piciacchia; Catherine Klersy; François Regoli; Barbara Petracci
- Source
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 23(11)
- Subject
- medicine.medical_specialty
Severe left atrial enlargement
medicine.medical_treatment
Catheter ablation
Ablation
Arrhythmic recurrences
Ventricular Function, Left
Pulmonary vein
Recurrence
Physiology (medical)
Internal medicine
Atrial Fibrillation
Left atrial enlargement
medicine
Humans
cardiovascular diseases
Heart Atria
Pulmonary veins isolation
Reduced left ventricular ejection fraction
Survival analysis
Ejection fraction
business.industry
Atrial fibrillation
Stroke Volume
medicine.disease
Treatment Outcome
Pulmonary Veins
Heart failure
cardiovascular system
Cardiology
Catheter Ablation
Cardiology and Cardiovascular Medicine
business
- Language
- ISSN
- 1532-2092
Aims Data regarding the efficacy of catheter ablation in heart failure patients with severely dilated left atrium and reduced left ventricular ejection fraction (LVEF) are scanty. We sought to assess the efficacy of catheter ablation in patients with reduced LVEF and severe left atrial (LA) enlargement, and to compare it to those patients with preserved left ventricular function and equally dilated left atrium. Methods and results Three patient groups with paroxysmal or persistent atrial fibrillation (AF) undergoing a first pulmonary vein isolation (PVI) were considered: Group 1 included patients with normal or mildly abnormal LA volume (≤41 mL/m2) and normal LVEF; Group 2 included patients with severe LA enlargement (>48 mL/m2) and normal LVEF; and Group 3 included patients with severe LA enlargement and reduced LVEF. Time to event analysis was used to investigate AF recurrences. The study cohort includes 439 patients; Group 3 had a higher prevalence of cardiovascular risk factors. LA enlargement was associated with a two-fold in risk of AF recurrence, on the contrary only a smaller non-significant increase of 30% was shown with the further addition of LVEF reduction. Conclusions The long-term outcome of patients with severe LA dilatation and reduced LVEF is comparable to those with severe LA enlargement but preserved LVEF. Long-term efficacy of PVI is certainly affected by the enlargement of the left atrium, but less so by the addition of a reduced LVEF. CA remains the best strategy for rhythm control both in paroxysmal and persistent AF in this subgroup of patients.