title: Catheter ablation for atrial fibrillation in congestive heart failure.
abstract: 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.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and Université Victor Ségalen, Bordeaux II, Bordeaux-Pessac, France.
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Stéphane
authors.initials: S
authors.lastname: Garrigue
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: 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