title: Long-term results of transcatheter atrial fibrillation ablation in patients with impaired left ventricular systolic function.
abstract: BACKGROUND
  Long-term outcome of AF ablation in patients with impaired LVEF is unknown. The aim of this study is to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters over a long-term period following atrial fibrillation (AF) transcatheter ablation in patients with left ventricular ejection fraction (LVEF) <50%.
  
  
  RESULTS
  A total of 196 patients (87.2% males, age 60.5 ± 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.4-63.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow-up, 58 (29.6%) patients required repeated ablations. At the follow-up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty-three (47.2%) patients maintained antiarrhythmic drugs. During follow-up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.69-10.74, P = 0.002) of long-term clinical improvement (reduction in NYHA class ≥ 1 and relative increase in LVEF ≥ 10%).
  
  
  CONCLUSIONS
  Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long-term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Stefano
authors.initials: S
authors.lastname: Grossi
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.forename: Francesca
authors.initials: F
authors.lastname: Bianchi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Senatore
authors.forename: Mario
authors.initials: M
authors.lastname: Matta
authors.forename: Dario
authors.initials: D
authors.lastname: Casolati
authors.forename: Federico
authors.initials: F
authors.lastname: Ferraris
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cristoforetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Negro
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000601:surgery*