title: Five-year outcomes of catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction.
abstract: BACKGROUND
  Catheter ablation of atrial fibrillation (AF) is an established therapy for symptomatic patients. The long-term efficacy and impact of catheter ablation among patients with severe systolic heart failure (SHF) requires additional study to understand if outcomes achieved at 1 year are maintained and mechanisms of AF recurrence.
  
  
  METHODS
  Three groups with SHF and 5 years of follow-up were matched 1:4:4 by age (±5 years) and sex: AF ablation patients receiving their first ablation (n = 267), AF patients that did not receive an ablation (n = 1,068), and SHF patient without AF (n = 1,068). SHF was based upon clinical diagnosis and an ejection fraction (EF) ≤35%. Patients were followed for 5-year primary outcomes of AF recurrence, heart failure, stroke, death, and cardiac function.
  
  
  RESULTS
  At 5 years, 60.7% of patients had clinical recurrence of AF. Diabetes and a prior heart attack were significant predictors of long-term risk of AF recurrence. Long-term mortality rates were 27%, 55%, 50%, in the AF ablation, AF, and no AF groups, respectively (P < 0.0001), with the lower rates attributed to lower cardiovascular mortality. At 5 years, there was no difference in EF, yet HF hospitalizations were lower following AF ablation compared to patients with AF and no ablation. Stroke rates at 5 years trended to be lower in the AF ablation group, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  Recurrence rates of AF in patients with SHF after ablation are common at 5 years with an anticipated ongoing increase. Long-term AF-related comorbidities tended to be less in the AF ablation group.
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Jacobs
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Crandall
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cutler
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mallender
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Osborn
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Day
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: atrial fibrillation; catheter ablation; heart failure; mortality; outcomes; stroke