Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control

Background Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF), but long-term outcomes are still unknown. Objective To assess the long-term effects of AF ablation in patients with systolic heart failure according to rhythm outcome. Methods We included 69 patients with LVEF ≤40%, referred for circumferential pulmonary vein isolation with or without additional substrate modification to our institution in 2006–2010. Follow-up included 7-day Holter electrocardiography and echocardiography at baseline and at 6, 12, and 24 months after ablation. A matched control group (n = 69) after AF ablation without heart failure was used for comparison. Results After 28 ± 11 months and 1.6 ± 0.7 ablation procedures, 45 (65%) patients were still in the stable sinus rhythm (SSR) group. LVEF increased from 33 ± 6% to 53 ± 11% ( P < .001) in the SSR group and from 33 ± 5% to 38 ± 12% ( P = .03) in patients with recurrences (atrial tachycardia/fibrillation group). While LVEF increase was similar in the 2 groups at 6 months (15 ± 12% vs 8 ± 11%; P = .2), further LVEF improvements were observed in the SSR group only. Adjustments for baseline characteristics revealed that the increase in LVEF at 6 months was associated with higher baseline heart rate and not with rhythm outcome. Heart rate did not change in either group after 6 months of follow-up. Complications and procedural data of the study group were similar to the control group. Conclusion In patients with heart failure undergoing AF ablation, there is an initial short-term LVEF improvement related to baseline heart rate. However, long-term LVEF improvement is associated with rhythm outcome.