title: Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: the importance of rhythm and rate control.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF), but long-term outcomes are still unknown.
  
  
  OBJECTIVE
  To assess the long-term effects of AF ablation in patients with systolic heart failure according to rhythm outcome.
  
  
  METHODS
  We included 69 patients with LVEF ≤40%, referred for circumferential pulmonary vein isolation with or without additional substrate modification to our institution in 2006-2010. Follow-up included 7-day Holter electrocardiography and echocardiography at baseline and at 6, 12, and 24 months after ablation. A matched control group (n = 69) after AF ablation without heart failure was used for comparison.
  
  
  RESULTS
  After 28 ± 11 months and 1.6 ± 0.7 ablation procedures, 45 (65%) patients were still in the stable sinus rhythm (SSR) group. LVEF increased from 33 ± 6% to 53 ± 11% (P < .001) in the SSR group and from 33 ± 5% to 38 ± 12% (P = .03) in patients with recurrences (atrial tachycardia/fibrillation group). While LVEF increase was similar in the 2 groups at 6 months (15 ± 12% vs 8 ± 11%; P = .2), further LVEF improvements were observed in the SSR group only. Adjustments for baseline characteristics revealed that the increase in LVEF at 6 months was associated with higher baseline heart rate and not with rhythm outcome. Heart rate did not change in either group after 6 months of follow-up. Complications and procedural data of the study group were similar to the control group.
  
  
  CONCLUSIONS
  In patients with heart failure undergoing AF ablation, there is an initial short-term LVEF improvement related to baseline heart rate. However, long-term LVEF improvement is associated with rhythm outcome.
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address: Sotirios.Nedios@herzzentrum-leipzig.de.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Second Cardiology Department, University of Athens, Attikon Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kanagkinis
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Borislav
authors.initials: B
authors.lastname: Dinov
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
keywords: Atrial fibrillation; Catheter ablation; Heart failure; Left ventricular dysfunction