Europace Advance Access originally published online on June 25, 2009
Europace 2009 11(8):1018-1023; doi:10.1093/europace/eup167
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Ablation for Atrial Fibrillation
Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication
1 Département de Rythmologie, Hôpital Privé Les Franciscaines, Unité de Cardiologie, Nîmes, France; 2 Département de Rythmologie, Clinique Pasteur, Toulouse, France; 3 Département de Cardiologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France; 4 Biosense-Webster France, Johnson & Johnson Medical, Issy les Molineaux, France
Aims: In the setting of congestive heart failure (CHF), atrial fibrillation (AF) ablation can improve clinical status and the left ventricular ejection fraction (LVEF) value. However, the impact of AF ablation on the implantable cardioverter defibrillator (ICD) indication has never been specifically addressed.
Methods and results: Study subject were six CHF (mean age 61.1 ± 6.9 years, mean LVEF 25.8 ± 7.3%) patients refractory to conventional medical treatment with long-lasting AF unresponsive to external cardioversion. Five patients had an idiopathic dilated cardiomyopathy (DCM) and one had an ischaemic cardiomyopathy (ICM). Their New York Heart Association (NYHA) class was III–IV. Two patients had renal insufficiency. No patient had left ventricular delay. All patients underwent AF ablation. LVEF and NYHA class were dramatically improved in the five DCM patients. New York Heart Association class, but not the LVEF, was improved in the ICM patient. A redo ablative procedure was undertaken in four of five DCM patients and in the ICM patient due to arrhythmia recurrence. Left ventricular ejection fraction and NYHA were improved again in the DCM patients (56 ± 4.4%, I–II, respectively) and led to ICD indication preclusion. The LVEF remained low in the ICM patient (30%) and led to ICD insertion. Sinus rhythm has been stable during the 18.1 ± 5.7 months follow-up period.
Conclusion: Atrial fibrillation ablation in CHF patients can improve both the clinical status of patients and their LVEF, especially among those affected by DCM. The LVEF improvement has the potential to preclude the indication for a primary prevention ICD insertion.
Key Words: Long-lasting atrial fibrillation, Catheter ablation, Congestive heart failure, Implantable, Cardioverter-defibrillator, Left ventricular ejection fraction, Outcome
* Corresponding author. Tel: +33 466266375, Fax: +33 466269728, Email: agubene{at}hotmail.com
Manuscript submitted 3 March 2009. Accepted after revision 1 June 2009.