title: Catheter ablation of atrial fibrillation in patients with heart failure: impact of maintaining sinus rhythm on heart failure status and long-term rates of stroke and death.
abstract: OBJECTIVE
  Catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) can improve left ventricular (LV) function and HF symptoms. We aimed to investigate whether long-term maintenance of sinus rhythm impacts on hard outcomes such as stroke and death.
  
  
  RESULTS
  An international multicentre registry was compiled from seven centres for consecutive patients undergoing catheter ablation of AF. Long-term freedom from AF was examined in patients with and without HF. The impact of maintaining sinus rhythm on rates of stroke and death was also examined. A total of 1273 patients were included: 171 with HF and 1102 without. Median follow-up was 3.1 years (IQR 2.0-4.3). The final procedure success rate was no different for paroxysmal AF (PAF) (78.7 vs. 85.7%, P = 0.186), but significantly different for persistent AF (57.3 vs. 75.8%, P < 0.001). Multivariate analysis showed that HF independently predicted recurrent arrhythmia [hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.002]. New York Heart Association class decreased from 2.3 ± 0.7 at baseline to 1.5 ± 0.8 at follow-up (P < 0.001). Left ventricular ejection fraction (LVEF) increased from 34.3 ± 9.0 to 45.8 ± 12.8% (P < 0.001). Recurrent AF was strongly predictive of stroke or death in HF patients (HR 8.33, 95% CI 1.86-37.7, P = 0.001).
  
  
  CONCLUSIONS
  Long-term success rates for persistent (but not paroxysmal) AF ablation are significantly lower in HF patients. Left ventricular function and HF symptoms were improved following ablation. In HF patients, recurrent arrhythmia strongly predicted stroke and death during follow-up.
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Waqas
authors: W
authors: Ullah
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia.
authors: Liang-Han
authors: LH
authors: Ling
authors: The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia.
authors: Sandeep
authors: S
authors: Prabhu
authors: The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia.
authors: Geoffrey
authors: G
authors: Lee
authors: The University of Melbourne and the Baker Heart Research Institute, Melbourne, Australia.
authors: Peter
authors: P
authors: Kistler
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Malcolm C
authors: MC
authors: Finlay
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK.
authors: Mark J
authors: MJ
authors: Earley
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK.
authors: Simon
authors: S
authors: Sporton
authors: Oxford University Hospitals NHS Trust John Radcliffe Hospital, Oxford, UK.
authors: Yaver
authors: Y
authors: Bashir
authors: Oxford University Hospitals NHS Trust John Radcliffe Hospital, Oxford, UK.
authors: Tim R
authors: TR
authors: Betts
authors: Oxford University Hospitals NHS Trust John Radcliffe Hospital, Oxford, UK.
authors: Kim
authors: K
authors: Rajappan
authors: Bristol Heart Institute, Bristol, UK.
authors: Glyn
authors: G
authors: Thomas
authors: Bristol Heart Institute, Bristol, UK.
authors: Edward
authors: E
authors: Duncan
authors: NUH Hospitals Trust, Nottingham, UK.
authors: Andrew
authors: A
authors: Staniforth
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Ian
authors: I
authors: Mann
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Anthony
authors: A
authors: Chow
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Pier
authors: P
authors: Lambiase
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK.
authors: Richard J
authors: RJ
authors: Schilling
authors: Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK The London AF centre, London Bridge Hospital, London, UK ross.hunter@bartshealth.nhs.uk.
authors: Ross J
authors: RJ
authors: Hunter
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001315:Australia; D017115:Catheter Ablation; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059035:Perioperative Period; D012008:Recurrence; D012042:Registries; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: AF; Catheter ablation; Heart failure; Mortality; Outcome; Stroke