title: Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication.
abstract: OBJECTIVE
  In the setting of congestive heart failure (CHF), atrial fibrillation (AF) ablation can improve clinical status and the left ventricular ejection fraction (LVEF) value. However, the impact of AF ablation on the implantable cardioverter defibrillator (ICD) indication has never been specifically addressed.
  
  
  RESULTS
  Study subject were six CHF (mean age 61.1 +/- 6.9 years, mean LVEF 25.8 +/- 7.3%) patients refractory to conventional medical treatment with long-lasting AF unresponsive to external cardioversion. Five patients had an idiopathic dilated cardiomyopathy (DCM) and one had an ischaemic cardiomyopathy (ICM). Their New York Heart Association (NYHA) class was III-IV. Two patients had renal insufficiency. No patient had left ventricular delay. All patients underwent AF ablation. LVEF and NYHA class were dramatically improved in the five DCM patients. New York Heart Association class, but not the LVEF, was improved in the ICM patient. A redo ablative procedure was undertaken in four of five DCM patients and in the ICM patient due to arrhythmia recurrence. Left ventricular ejection fraction and NYHA were improved again in the DCM patients (56 +/- 4.4%, I-II, respectively) and led to ICD indication preclusion. The LVEF remained low in the ICM patient (30%) and led to ICD insertion. Sinus rhythm has been stable during the 18.1 +/- 5.7 months follow-up period.
  
  
  CONCLUSIONS
  Atrial fibrillation ablation in CHF patients can improve both the clinical status of patients and their LVEF, especially among those affected by DCM. The LVEF improvement has the potential to preclude the indication for a primary prevention ICD insertion.
authors: Département de Rythmologie, Hôpital Privé Les Franciscaines, Unité de Cardiologie, Nîmes, France. agubene@hotmail.com
authors: Agustín
authors: A
authors: Bortone
authors: Serge
authors: S
authors: Boveda
authors: Jean-Luc
authors: JL
authors: Pasquié
authors: Pénélope
authors: P
authors: Pujadas-Berthault
authors: Eloi
authors: E
authors: Marijon
authors: Anthony
authors: A
authors: Appetiti
authors: Jean-Paul
authors: JP
authors: Albenque
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000517:prevention & control*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016896:Treatment Outcome