Waqas Ullah1, Liang-Han Ling2, Sandeep Prabhu3, Geoffrey Lee3, Peter Kistler3, Malcolm C Finlay1, Mark J Earley4, Simon Sporton4, Yaver Bashir5, Tim R Betts5, Kim Rajappan5, Glyn Thomas6, Edward Duncan6, Andrew Staniforth7, Ian Mann1, Anthony Chow1, Pier Lambiase1, Richard J Schilling4, Ross J Hunter8. 1. Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK. 2. Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia. 3. The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia. 4. Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK. 5. Oxford University Hospitals NHS Trust John Radcliffe Hospital, Oxford, UK. 6. Bristol Heart Institute, Bristol, UK. 7. NUH Hospitals Trust, Nottingham, UK. 8. Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK ross.hunter@bartshealth.nhs.uk.
Abstract
AIMS: Catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) can improve left ventricular (LV) function and HF symptoms. We aimed to investigate whether long-term maintenance of sinus rhythm impacts on hard outcomes such as stroke and death. METHODS AND RESULTS: An international multicentre registry was compiled from seven centres for consecutive patients undergoing catheter ablation of AF. Long-term freedom from AF was examined in patients with and without HF. The impact of maintaining sinus rhythm on rates of stroke and death was also examined. A total of 1273 patients were included: 171 with HF and 1102 without. Median follow-up was 3.1 years (IQR 2.0-4.3). The final procedure success rate was no different for paroxysmal AF (PAF) (78.7 vs. 85.7%, P = 0.186), but significantly different for persistent AF (57.3 vs. 75.8%, P < 0.001). Multivariate analysis showed that HF independently predicted recurrent arrhythmia [hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.002]. New York Heart Association class decreased from 2.3 ± 0.7 at baseline to 1.5 ± 0.8 at follow-up (P < 0.001). Left ventricular ejection fraction (LVEF) increased from 34.3 ± 9.0 to 45.8 ± 12.8% (P < 0.001). Recurrent AF was strongly predictive of stroke or death in HF patients (HR 8.33, 95% CI 1.86-37.7, P = 0.001). CONCLUSION: Long-term success rates for persistent (but not paroxysmal) AF ablation are significantly lower in HF patients. Left ventricular function and HF symptoms were improved following ablation. In HF patients, recurrent arrhythmia strongly predicted stroke and death during follow-up. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) can improve left ventricular (LV) function and HF symptoms. We aimed to investigate whether long-term maintenance of sinus rhythm impacts on hard outcomes such as stroke and death. METHODS AND RESULTS: An international multicentre registry was compiled from seven centres for consecutive patients undergoing catheter ablation of AF. Long-term freedom from AF was examined in patients with and without HF. The impact of maintaining sinus rhythm on rates of stroke and death was also examined. A total of 1273 patients were included: 171 with HF and 1102 without. Median follow-up was 3.1 years (IQR 2.0-4.3). The final procedure success rate was no different for paroxysmal AF (PAF) (78.7 vs. 85.7%, P = 0.186), but significantly different for persistent AF (57.3 vs. 75.8%, P < 0.001). Multivariate analysis showed that HF independently predicted recurrent arrhythmia [hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.002]. New York Heart Association class decreased from 2.3 ± 0.7 at baseline to 1.5 ± 0.8 at follow-up (P < 0.001). Left ventricular ejection fraction (LVEF) increased from 34.3 ± 9.0 to 45.8 ± 12.8% (P < 0.001). Recurrent AF was strongly predictive of stroke or death in HF patients (HR 8.33, 95% CI 1.86-37.7, P = 0.001). CONCLUSION: Long-term success rates for persistent (but not paroxysmal) AF ablation are significantly lower in HF patients. Left ventricular function and HF symptoms were improved following ablation. In HF patients, recurrent arrhythmia strongly predicted stroke and death during follow-up. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Mark K Elliott; Vishal S Mehta; Dejana Martic; Baldeep S Sidhu; Steven Niederer; Christopher A Rinaldi Journal: Heart Rhythm O2 Date: 2021-12-17
Authors: Stephan Willems; Christian Meyer; Joseph de Bono; Axel Brandes; Lars Eckardt; Arif Elvan; Isabelle van Gelder; Andreas Goette; Michele Gulizia; Laurent Haegeli; Hein Heidbuchel; Karl Georg Haeusler; Josef Kautzner; Lluis Mont; G Andre Ng; Lukasz Szumowski; Sakis Themistoclakis; Karl Wegscheider; Paulus Kirchhof Journal: Eur Heart J Date: 2019-12-07 Impact factor: 29.983