title: The Impact of Known Heart Disease on Long-Term Outcomes of Catheter Ablation in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction: A Multicenter International Study.
abstract: BACKGROUND
  Catheter ablation for AF is an effective treatment for patients with AF and systolic LV dysfunction; however, the clinical outcome is variable. We evaluated the impact of cardiomyopathy etiology on long-term outcomes post-catheter ablation.
  
  
  METHODS
  Patients undergoing AF ablation across 3 centers (2 Australian, 1 UK) from 2002 to 2014, with LVEF<45% were evaluated. Patients were stratified into those with known heart disease as a cause of cardiomyopathy (KHD), and those with idiopathic dilated cardiomyopathy (IDCM).
  
  
  RESULTS
  One hundred and one patients (IDCM = 77, KHD = 24) with AF and LVEF <45% underwent AF ablation. The KHD group (ischemic HD in 67%) were older (61 ± 7 vs. 55 ± 11 years, P = 0.005), with a higher CHADS2 score (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.016), but otherwise well matched. After mean follow-up of 36 ± 23 months, AF control was greater in the IDCM group (82% vs. 50% in KHD, P < 0.001). On multivariate analysis IDCM was associated with long-term AF control (P = 0.033). The IDCM group had less functional impairment at follow-up (NYHA class 1.5 ± 0.7 vs. 2.0 ± 0.8, P = 0.005) and improved LVEF (50 ± 11% vs. 38 ± 10%, P < 0.001). Super responders (EF improvement >15%) were overwhelmingly in the IDCM group (94% vs. 6%, P < 0.001) with greater AF control (89% vs. 61%, P < 0.001). All-cause mortality was significantly higher in the KHD group (17% vs. 1.3%, P = 0.002).
  
  
  CONCLUSIONS
  IDCM was associated with greater AF control, and improvement in symptoms and LVEF compared to patients with KHD post-AF ablation. AF is an important reversible cause of HF in patients with an unexplained CM and catheter ablation an effective treatment option.
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.|Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Liang-Han
authors.initials: LH
authors.lastname: Ling
authors.affiliation: Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Waqas
authors.initials: W
authors.lastname: Ullah
authors.affiliation: Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.affiliation: Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.|Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Alex J A
authors.initials: AJ
authors.lastname: McLellan
authors.affiliation: Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.affiliation: Department of Cardiology, St. Batholomew's Hospital, London, United Kingdom.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Sporton
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Voskoboinik
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Blusztein
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Mariani
authors.affiliation: Baker IDI Heart and Diabetes Institute, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Victoria, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: Department of Cardiology, Alfred Hospital, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*
keywords: atrial fibrillation; catheter ablation; coronary artery disease; idiopathic cardiomyopathy; known heart disease