Atrial fibrillation ablation in systolic dysfunction: clinical and echocardiographic outcomes.
BACKGROUND
Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle.


OBJECTIVE
To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation.


METHODS
Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation.


RESULTS
31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8 ± 10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3 ± 17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23 ± 0.56; postablation: 1.13 ± 0.35; p < 0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68% ± 6.02%, post: 59% ± 13.2%, p = 0.0005) and a significant left atrial diameter reduction (pre: 46.61 ± 7.3 mm; post: 43.59 ± 6.6 mm; p = 0.026). No major complications occurred.


CONCLUSIONS
Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Tasso Julio
TJ
Lobo
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Carlos Thiene
CT
Pachon
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Jose Carlos
JC
Pachon
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Enrique Indalecio
EI
Pachon
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Maria Zelia
MZ
Pachon
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Juan Carlos
JC
Pachon
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Tomas Guillermo
TG
Santillana
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Juan Carlos
JC
Zerpa
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Remy Nelson
RN
Albornoz
Serviço de Arritmias - Eletrofisiologia e Marca-passo, Hospital do Coração de São Paulo Hcor, São Paulo, SP, Brazil.
Adib Domingos
AD
Jatene
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*