Journal of Arrhythmia (Dec 2012)

Outcomes after stepwise ablation for persistent atrial fibrillation in patients with heart failure

  • Yoshihide Takahashi, MD,
  • Atsushi Takahashi, MD,
  • Taishi Kuwahara, MD,
  • Kenji Okubo, MD,
  • Katsumasa Takagi, MD,
  • Yuji Watari, MD,
  • Masateru Takigawa, MD,
  • Emiko Nakashima, MD,
  • Naohiko Kawaguchi, MD,
  • Kazuya Yamao, MD,
  • Kenzo Hirao, MD,
  • Mitsuaki Isobe, MD

DOI
https://doi.org/10.1016/j.joa.2012.05.010
Journal volume & issue
Vol. 28, no. 6
pp. 347 – 352

Abstract

Read online

Background: There is limited data regarding the outcomes after stepwise ablation for persistent atrial fibrillation (AF) in patients with heart failure (HF). Methods and results: Patients without structural heart disease undergoing stepwise ablation for persistent AF (continuous AF≤1 year) were studied (n=108; age, 61±10 years) and 32 patients had a history of HF. The HF patients were further grouped on the basis of left ventricular ejection fraction (LVEF)≤45% (n=15) and >45% (n=17). During a median follow-up period of 2.2 years, repeated ablations were necessary in 65 patients. The proportion of patients that were arrhythmia free 1 year after the last ablation was 67% in patients with LVEF≤45%, 86% in LVEF>45%, and 91% in no HF (p=0.0009). In patients with LVEF≤45%, the AF burden was reduced to less than one paroxysmal episode per month, and patients with and without recurrences both showed significant increases in LVEF over the follow-up period (38±7% to 60±10% and 37±6% to 53±10%, respectively). Conclusions: HF patients with LVEF≤45% had lower chances to remain free from arrhythmias after stepwise ablation for persistent AF than those with LVEF>45%. Nevertheless, LVEF also improved in patients with recurrences, reflecting the observed reduction in AF burden and emphasizing the benefits of ablation.

Keywords