Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication
Bortone A et al. – Atrial fibrillation ablation in congestive heart failure (CHF) pts can improve both the clinical status of patients and their left ventricular ejection fraction (LVEF) value, especially among pts affected by dilated cardiomyopathy (DCM). The LVEF improvement has the potential to preclude the indication for a primary prevention implantable cardioverter defibrillator (ICD) insertion. Methods- Subjects: 6 CHF (mean age 61.1 ± 6.9 yrs, mean LVEF 25.8 ± 7.3%) pts refractory to conventional medical treatment with long-term AF unresponsive to external cardioversion
- Idiopathic DCM in 5 pts; ischaemic cardiomyopathy (ICM) in 1 pt
- NYHA class: III–IV
- Renal insufficiency in 2 pts
- No left ventricular delay
- AF ablation for all pts
Results- LVEF and NYHA class dramatically improved in 5 DCM pts
- NYHA class, but not LVEF, improved in ICM pt
- Redo ablative procedure in 4 pf 5 DCM pts and in ICM pt due to arrhythmia recurrence
- LVEF and NYHA improved in DCM pts, leading to ICD indication preclusion
- LVEF remained low in ICM pt, leading to ICD insertion
- Sinus rhythm stable during 18.1 ± 5.7 mo follow-up period
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