Six-Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function

Introduction: Long-term data after pulmonary vein isolation (PVI) in patients with impaired systolic left ventricular ejection fraction (LVEF) are sparse. This study assessed the outcomes in patients with atrial fibrillation (AF) and reduced LVEF treated with PVI after a median follow-up period of 6 years.

Methods and results: Eighty-one patients with an LVEF≤45% were evaluated; however, 1 patient was lost to follow-up. In the remaining 80 patients (male: n = 68 (85%), median age 61.6 (54.8-67.5) years) with paroxysmal (n = 16, 20%), persistent (n = 37, 46.2%), and longstanding-persistent AF (LS-AF), catheter ablation of AF using radiofrequency and 3D mapping was performed. Follow-up included Holter monitoring or pacemaker/ICD interrogation to assess for arrhythmia recurrence and echocardiography to assess LVEF. Median follow-up was 72 (67-75) months. Death occurred in 21 patients. Single-procedure success rate was 35.1% and multiple-procedure success rate was 56.8% in the overall group. Baseline median LVEF (35% [28.5-40%]) significantly increased at 6-year follow-up (56.5% [40.0-60.0%], P < 0.01). In patients with single- or multiple-procedure ablation success, there was a higher improvement of LVEF (single procedure: 25% [15.0-35] vs. 10.0% [-1.0-20.0], P < 0.01; multiple procedures: 20.0% [15-34] vs. 5.0% [5.00-15.0]; P < 0.01). The single (43.8% vs. 40%, P = 0.96) and multiple procedure success rates (62.5% vs. 60%, P = 0.47) were comparable between patients with PAF and persistent AF and lowest in patients with LS-AF (single procedure success: 23.1%, multiple-procedure success: 47.8%).

Conclusion: Single-procedure success rates after PVI during 6 years of follow-up were low. In patients with single- or multiple-procedure ablation success, a higher improvement of LVEF was observed.