title: Catheter ablation in selected patients with depressed left ventricular ejection fraction and persistent atrial fibrillation unresponsive to current cardioversion.
abstract: OBJECTIVE
  In congestive heart failure (CHF) patients with persistent atrial fibrillation (AF), direct current cardioversion (DCC) may reveal participation of tachycardiamediated process to left ventricular (LV) dysfunction by restoring sinus rhythm (SR). However, if DCC fails to restore SR, patients' management remains challenging. The aim of the study was to assess the AF catheter ablation benefit in a selected group of CHF patients with LV ejection fraction (LVEF) <40% and persistent AF unresponsive to DCC, in whom a tachycardia-mediated process is thought to be predominant.
  
  
  RESULTS
  Between January 2008 and September 2011, among 129 CHF patients with persistent AF referred to our institution, 34 (63.8 ± 9-year old, 24 men) presented AF refractory to DCC with an estimated high likelihood of tachycardia-mediated LV dysfunction according to a specific set of criteria. These 34 patients underwent stepwise AF ablation and were closely followed up. After a mean 1.9 AF ablation procedures per patient and 17.6 ± 7 months after the last procedure, all patients were in SR. The New York Heart Association class improved from 2.8 ± 0.3 to 1 ± 0.2 (P< 0.001) and the LVEF increased from 30.4 ± 6 to 54.6 ± 6% (P< 0.0001) after 3-6 months of SR, with a persistent benefit as long as the SR was maintained.
  
  
  CONCLUSIONS
  Atrial fibrillation catheter ablation in selected CHF patients with persistent AF refractory to DCC and without any other evidence for secondary LV dysfunction leads to a substantial LVEF improvement in the majority of them. However, redo procedures are frequent in order to achieve mid-term SR maintenance.
authors.affiliation: Département de Rythmologie, Unité de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
authors.forename: Agustín
authors.initials: A
authors.lastname: Bortone
authors.forename: Pénélope
authors.initials: P
authors.lastname: Pujadas-Berthault
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.forename: Eric
authors.initials: E
authors.lastname: Maupas
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Boulenc
authors.forename: Philippe
authors.initials: P
authors.lastname: Rioux
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dürrleman
authors.forename: Vlad
authors.initials: V
authors.lastname: Ciobotaru
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D019468:Disease Management; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D018579:Patient Selection; D012189:Retrospective Studies; D012849:Sinoatrial Node / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D017211:Treatment Failure; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*
keywords: Catheter ablation; Congestive heart failure; Persistent atrial fibrillation