Different Approaches to Atrial Fibrillation Ablation in Heart Failure Patients: Temporal Trends and Clinical Outcomes.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2025-01-23 DOI:10.1016/j.jacep.2024.12.004

Marco Bergonti, Philipp Krisai, Ciro Ascione, Thomas Pambrun, Domenico G Della Rocca, Paolo Compagnucci, Tardu Özkartal, Lorenzo Marcon, Teba Gonzalez Ferrero, Luigi Pannone, Michael Kühne, Matteo Anselmino, Michela Casella, Teodor Serban, Claudio Tondo, Moises Rodríguez-Mañero, Maria Luce Caputo, Patrick Badertscher, Nicolas Derval, Carlo de Asmundis, Gian Battista Chierchia, Hein Heidbuchel, Pierre Jaïs, Angelo Auricchio, Andrea Sarkozy, Giulio Conte

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引用次数: 0

Abstract

Background: Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.

Objectives: This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.

Methods: Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.

Results: A total of 955 HFrEF patients (62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).

Conclusions: Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.