Catheter ablation for atrial fibrillation in congestive heart failure.
BACKGROUND
Congestive heart failure and atrial fibrillation often coexist, and each adversely affects the other with respect to management and prognosis. We prospectively evaluated the effect of catheter ablation for atrial fibrillation on left ventricular function in patients with heart failure.


METHODS
We studied 58 consecutive patients with congestive heart failure and a left ventricular ejection fraction of less than 45 percent who were undergoing catheter ablation for atrial fibrillation. We selected as controls 58 patients without congestive heart failure who were undergoing ablation for atrial fibrillation, matched according to age, sex, and classification of atrial fibrillation. We evaluated the patients' left ventricular function and dimensions, symptom score, exercise capacity, and quality of life at baseline and at months 1, 3, 6, and 12.


RESULTS
After a mean (+/-SD) of 12+/-7 months, 78 percent of the patients with congestive heart failure and 84 percent of the controls remained in sinus rhythm (P=0.34) (69 percent and 71 percent, respectively, were in sinus rhythm without the administration of antiarrhythmic drugs). The patients with congestive heart failure had significant improvement in left ventricular function (increases in the ejection fraction and fractional shortening of 21+/-13 percent and 11+/-7 percent, respectively; P<0.001 for both comparisons), left ventricular dimensions (decreases in the diastolic and systolic diameters of 6+/-6 mm and 8+/-7 mm, respectively; P=0.03 and P<0.001, respectively), exercise capacity, symptoms, and quality of life. The ejection fraction improved significantly not only in patients without concurrent structural heart disease (24+/-10 percent, P<0.001) and those with inadequate rate control before ablation (23+/-10 percent, P<0.001), but also in those with coexisting heart disease (16+/-14 percent, P<0.001) and adequate rate control before ablation (17+/-15 percent, P<0.001).


CONCLUSIONS
Restoration and maintenance of sinus rhythm by catheter ablation without the use of drugs in patients with congestive heart failure and atrial fibrillation significantly improve cardiac function, symptoms, exercise capacity, and quality of life.
Hsu
Li-Fern
LF
Hôpital Cardiologique du Haut-Lévêque and Université Victor Ségalen, Bordeaux II, Bordeaux-Pessac, France.
Jaïs
Pierre
P
Sanders
Prashanthan
P
Garrigue
Stéphane
S
Hocini
Mélèze
M
Sacher
Fréderic
F
Takahashi
Yoshihide
Y
Rotter
Martin
M
Pasquié
Jean-Luc
JL
Scavée
Christophe
C
Bordachar
Pierre
P
Clémenty
Jacques
J
Haïssaguerre
Michel
M
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D013318:Stroke Volume