Long-Term Results of Transcatheter Atrial Fibrillation Ablation in Patients with Impaired Left Ventricular Systolic Function

被引:34
作者
Anselmino, Matteo [1 ]
Grossi, Stefano [2 ]
Scaglione, Marco [3 ]
Castagno, Davide [1 ]
Bianchi, Francesca [2 ]
Senatore, Gaetano [4 ]
Matta, Mario [1 ]
Casolati, Dario [1 ]
Ferraris, Federico [1 ]
Cristoforetti, Yvonne [1 ]
Negro, Alessandro [1 ]
Gaita, Fiorenzo [1 ]
机构
[1] Univ Turin, Dept Internal Med, Div Cardiol, San Giovanni Battista Hosp, I-10126 Turin, Italy
[2] Mauriziano Umberto I Hosp, Div Cardiol, Turin, Italy
[3] Cardinal Guglielmo Massaia Hosp, Div Cardiol, Asti, Italy
[4] Civ Hosp Cirie Turin, Turin, Italy
关键词
atrial fibrillation; catheter ablation; heart failure; left ventricular ejection fraction; sudden death; RADIOFREQUENCY CATHETER ABLATION; ACC/AHA/ESC; 2006; GUIDELINES; PULMONARY-VEIN ISOLATION; MAGNETIC-RESONANCE; EUROPEAN-SOCIETY; CEREBRAL THROMBOEMBOLISM; HEART-FAILURE; TASK-FORCE; MANAGEMENT; EFFICACY;
D O I
10.1111/j.1540-8167.2012.02419.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AF Ablation and Impaired Left Ventricular Function. Introduction: Long-term outcome of AF ablation in patients with impaired LVEF is unknown. The aim of this study is to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters over a long-term period following atrial fibrillation (AF) transcatheter ablation in patients with left ventricular ejection fraction (LVEF) <50%. Methods and Results: A total of 196 patients (87.2% males, age 60.5 +/- 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.463.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow-up, 58 (29.6%) patients required repeated ablations. At the follow-up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty-three (47.2%) patients maintained antiarrhythmic drugs. During follow-up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.6910.74, P = 0.002) of long-term clinical improvement (reduction in NYHA class =1 and relative increase in LVEF =10%). Conclusions: Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long-term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement. (J Cardiovasc Electrophysiol, Vol. 24, pp. 24-32, January 2013)
引用
收藏
页码:24 / 32
页数:9
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