Pulmonary vein vestibule ablation for the control of atrial fibrillation in patients with impaired left ventricular function.
BACKGROUND
Congestive heart failure (CHF) and atrial fibrillation (AF) are frequently linked, and when associated produce additive deleterious effects. In this prospective study, the effects of catheter ablation for AF in patients with impaired left ventricular (LV) function are presented.


METHODS
Baseline data and clinical outcome have been prospectively collected in 105 consecutive patients who underwent pulmonary vein ablation for the control of AF. We evaluated 40 patients affected by LV dysfunction with ejection fraction (EF)<40% and compared them to the remaining 65 patients with normal ventricular function in terms of changes in LV function, maintenance of sinus rhythm, and quality of life during follow-up.


RESULTS
After a mean follow-up of 14+/-2 months, 87% of patients with impaired LV function and 92% of patients with normal ventricular function were in sinus rhythm, with or without antiarrhythmic therapy (P=NS). A significant improvement in LVEF and fractional shortening was documented in patients with CHF (33+/-2% vs 47+/-3%, and 19+/-4% vs 30+/-3%, P<0.01 for both comparisons). Evaluation of exercise capacity and quality of life documented better improvements in patients with CHF compared to patients without CHF.


CONCLUSIONS
Catheter ablation in patients with LV dysfunction is feasible, not associated with higher procedural complications, and provides a significant improvement in LV performance, symptoms, and quality of life during follow-up.
Tondo
Claudio
C
Division of Cardiology, Cardiac Arrhythmia Center and Heart Failure Unit, St. Camillo-Forlanini Hospital, Rome, and Arrhythmia Unit, St. Ambrogio's Clinical Institute, University of Milan, Italy. c.tondo@libero.it
Mantica
Massimo
M
Russo
Giovanni
G
Avella
Andrea
A
De Luca
Lucia
L
Pappalardo
Augusto
A
Fagundes
Rafael Lopes
RL
Picchio
Edo
E
Laurenzi
Francesco
F
Piazza
Vito
V
Bisceglia
Irma
I
D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000517:prevention & control*