Matteo Anselmino1, Mario Matta1, Fabrizio D'Ascenzo1, T Jared Bunch1, Richard J Schilling1, Ross J Hunter1, Carlo Pappone1, Thomas Neumann1, Georg Noelker1, Martin Fiala1, Emanuele Bertaglia1, Antonio Frontera1, Edward Duncan1, Chrishan Nalliah1, Pierre Jais1, Rukshen Weerasooriya1, Jon M Kalman1, Fiorenzo Gaita2. 1. From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim (T.N.); Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (G.N.); Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic (M.F.); Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy (E.B.); Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, United Kingdom (A.F., E.D.); Department of Cardiology, Westmead Hospital, Sydney, Australia (C.N.); Department of Cardiology, University of Sydney, Sydney, Australia (C.N.); Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France (P.J., R.W.); Department of Cardiology, University of Western Australia, Crawley, Western Australia (R.W.); and Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (J.M.K.). 2. From the Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy (M.A., M.M., F.D.A., F.G.); Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B.); Cardiovascular Biomedical Research Unit, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (R.J.S., R.J.H.); Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (C.P.); Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim (T.N.); Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (G.N.); Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic (M.F.); Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy (E.B.); Department of Cardiology, Bristol Heart Institute, University Hospital Bristol NHS Trust, Bristol, United Kingdom (A.F., E.D.); Department of Cardiology, Westmead Hospital, Sydney, Australia (C.N.); Department of Cardiology, University of Sydney, Sydney, Australia (C.N.); Department of Cardiac Electrophysiology, Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France (P.J., R.W.); Department of Cardiology, University of Western Australia, Crawley, Western Australia (R.W.); and Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (J.M.K.). fiorenzo.gaita@unito.it.
Abstract
BACKGROUND: Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function. METHODS AND RESULTS: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18-40) months. Overall complication rate was 4.2% (3.6%-4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%-67%). Meta-regression analysis revealed that time since first atrial fibrillation (P=0.030) and heart failure (P=0.045) diagnosis related to higher, whereas absence of known structural heart disease (P=0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (P<0.001), with a significant reduction of patients presenting an ejection fraction <35% (P<0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL (P<0.001). CONCLUSIONS: AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.
BACKGROUND: Catheter ablation of atrial fibrillation (AFCA) is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. We performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function. METHODS AND RESULTS: A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomized controlled trials, clinical trials, and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. Twenty-six studies were selected, including 1838 patients. Mean follow-up was 23 (95% confidence interval, 18-40) months. Overall complication rate was 4.2% (3.6%-4.8%). Efficacy in maintaining sinus rhythm at follow-up end was 60% (54%-67%). Meta-regression analysis revealed that time since first atrial fibrillation (P=0.030) and heart failure (P=0.045) diagnosis related to higher, whereas absence of known structural heart disease (P=0.003) to lower incidence of atrial fibrillation recurrences. Left ventricular ejection fraction improved significantly during follow-up by 13% (P<0.001), with a significant reduction of patients presenting an ejection fraction <35% (P<0.001). N-terminal pro-brain natriuretic peptide blood levels decreased by 620 pg/mL (P<0.001). CONCLUSIONS:AFCA efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation and heart failure. AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function.
Authors: Liang-Han Ling; Peter M Kistler; Jonathan M Kalman; Richard J Schilling; Ross J Hunter Journal: Nat Rev Cardiol Date: 2015-12-10 Impact factor: 32.419
Authors: Shadi Al Halabi; Mohammed Qintar; Ayman Hussein; M Chadi Alraies; David G Jones; Tom Wong; Michael R MacDonald; Mark C Petrie; Daniel Cantillon; Khaldoun G Tarakji; Mohamed Kanj; Mandeep Bhargava; Niraj Varma; Bryan Baranowski; Bruce L Wilkoff; Oussama Wazni; Thomas Callahan; Walid Saliba; Mina K Chung Journal: JACC Clin Electrophysiol Date: 2015-06-01