Catheter Ablation for Atrial Fibrillation Targeting Incremental Left Ventricular Ejection Fraction.

To the Editor:

Atrial fibrillation (AF) has a considerable association with heart failure (HF). Recent studies demonstrated that rhythm control using catheter ablation for AF could facilitate cardiac reverse remodeling and improve clinical outcomes in carefully selected patients with systolic HF. Yazaki et al demonstrated that an incremental improvement in left ventricular ejection fraction (LVEF) following catheter ablation for AF was associated with a greater clinical outcome compared with persistently impaired cardiac function.

Yazaki et al stratified clinical outcomes by post-procedural LVEF status. Post-procedural clinical outcomes stratified by improvement in cardiac function vs. remaining cardiac function would be of great interest. Following catheter ablation, a recurrence of atrial tachyarrhythmia was associated with persistently impaired cardiac function. Analyses to investigate any other risk factors for persistently reduced ejection fraction would help clinicians with risk stratification and optimal patient selection. For example, shorter HF duration and non-ischemic etiology with reduced myocardial scar may be key to improved cardiac function following catheter ablation.

In the study of Yazaki et al, some patients underwent multiple catheter ablations to treat recurrent atrial tachyarrhythmia. The next concern is whether such interventions could also ameliorate cardiac function, as well as clinical outcomes, following recovery to sinus rhythm.

Disclosures

T.I. receives grant support from JSPS KAKENHI (No. JP20K17143).

Mimi Chapman

Teruhiko Imamura, MD, PhD

Second Department of Internal Medicine, University of Toyama, Toyama, Japan