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...
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| Veröffentlicht in: | Heart rhythm 2014-03, Vol.11 (3), p.344-351 |
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| creator | Nedios, Sotirios, MD Sommer, Philipp, MD, FHRS Dagres, Nikolaos, MD Kosiuk, Jedrzej, MD Arya, Arash, MD Richter, Sergio, MD Gaspar, Thomas, MD Kanagkinis, Nikolaos, MD Dinov, Borislav, MD Piorkowski, Christopher, MD Bollmann, Andreas, MD, PhD Hindricks, Gerhard, MD, FHRS Rolf, Sascha, MD |
| description | 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. |
| doi_str_mv | 10.1016/j.hrthm.2013.12.031 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1501835243</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1547527113014793</els_id><sourcerecordid>1501835243</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-9c92f2f9f4e9a6b2f12fc9b7d8de5f9883a5ba003243c334085b5cd9515cf5de3</originalsourceid><addsrcrecordid>eNqFksuO1DAQRS0EYoaBL0BCXrJJ8CPuJEggjUa8pJZYMKwtxykTN44dbGdG_TN8Kw7dsGDDyiX7Hpdu3ULoOSU1JXT36lBPMU9zzQjlNWU14fQBuqRC7CretfThVjdtJVhLL9CTlA6EsH5H-GN0wRreNpyRS_RzH_y3KkOcsQnOhftqXbAy5QKrHK1y2NghWudUtsFjNZwL6_FSKvA54XubJ2znRdkII3ZgMr4rD9Hq1amI0zHl4KzGZvV6g1_j2wk2IMSsvAYcDI7TsXjByo84qgxYh_JBcE_RI6Ncgmfn8wp9ff_u9uZjtf_84dPN9b7SDW1y1eueGWZ600CvdgMzlBndD-3YjSBM33VciUERwotxzXlDOjEIPfaCCm3ECPwKvTz9u8TwY4WU5WyThmLbQ1iTpILQjouCFyk_SXUMKUUwcol2VvEoKZFbMPIgfwcjt2AkZbIEU6gX5wbrMMP4l_mTRBG8OQmg2LyzEGXSZbwaxjJVneUY7H8avP2H1856q5X7DkdIh7BGXyYoqUwFkF-23dhWg3JCm7bn_Bcnr7k3</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1501835243</pqid></control><display><type>article</type><title>Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><creator>Nedios, Sotirios, MD ; Sommer, Philipp, MD, FHRS ; Dagres, Nikolaos, MD ; Kosiuk, Jedrzej, MD ; Arya, Arash, MD ; Richter, Sergio, MD ; Gaspar, Thomas, MD ; Kanagkinis, Nikolaos, MD ; Dinov, Borislav, MD ; Piorkowski, Christopher, MD ; Bollmann, Andreas, MD, PhD ; Hindricks, Gerhard, MD, FHRS ; Rolf, Sascha, MD</creator><creatorcontrib>Nedios, Sotirios, MD ; Sommer, Philipp, MD, FHRS ; Dagres, Nikolaos, MD ; Kosiuk, Jedrzej, MD ; Arya, Arash, MD ; Richter, Sergio, MD ; Gaspar, Thomas, MD ; Kanagkinis, Nikolaos, MD ; Dinov, Borislav, MD ; Piorkowski, Christopher, MD ; Bollmann, Andreas, MD, PhD ; Hindricks, Gerhard, MD, FHRS ; Rolf, Sascha, MD</creatorcontrib><description>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.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2013.12.031</identifier><identifier>PMID: 24374320</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Cardiovascular ; Case-Control Studies ; Catheter ablation ; Catheter Ablation - methods ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies ; Heart failure ; Heart Rate - physiology ; Humans ; Left ventricular dysfunction ; Middle Aged ; Pulmonary Veins - surgery ; Systole ; Treatment Outcome ; Ventricular Dysfunction, Left - complications ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Dysfunction, Left - surgery</subject><ispartof>Heart rhythm, 2014-03, Vol.11 (3), p.344-351</ispartof><rights>Heart Rhythm Society</rights><rights>2014 Heart Rhythm Society</rights><rights>Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-9c92f2f9f4e9a6b2f12fc9b7d8de5f9883a5ba003243c334085b5cd9515cf5de3</citedby><cites>FETCH-LOGICAL-c414t-9c92f2f9f4e9a6b2f12fc9b7d8de5f9883a5ba003243c334085b5cd9515cf5de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2013.12.031$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24374320$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nedios, Sotirios, MD</creatorcontrib><creatorcontrib>Sommer, Philipp, MD, FHRS</creatorcontrib><creatorcontrib>Dagres, Nikolaos, MD</creatorcontrib><creatorcontrib>Kosiuk, Jedrzej, MD</creatorcontrib><creatorcontrib>Arya, Arash, MD</creatorcontrib><creatorcontrib>Richter, Sergio, MD</creatorcontrib><creatorcontrib>Gaspar, Thomas, MD</creatorcontrib><creatorcontrib>Kanagkinis, Nikolaos, MD</creatorcontrib><creatorcontrib>Dinov, Borislav, MD</creatorcontrib><creatorcontrib>Piorkowski, Christopher, MD</creatorcontrib><creatorcontrib>Bollmann, Andreas, MD, PhD</creatorcontrib><creatorcontrib>Hindricks, Gerhard, MD, FHRS</creatorcontrib><creatorcontrib>Rolf, Sascha, MD</creatorcontrib><title>Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>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.</description><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiovascular</subject><subject>Case-Control Studies</subject><subject>Catheter ablation</subject><subject>Catheter Ablation - methods</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Electrocardiography, Ambulatory</subject><subject>Follow-Up Studies</subject><subject>Heart failure</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Left ventricular dysfunction</subject><subject>Middle Aged</subject><subject>Pulmonary Veins - surgery</subject><subject>Systole</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Left - complications</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Dysfunction, Left - surgery</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFksuO1DAQRS0EYoaBL0BCXrJJ8CPuJEggjUa8pJZYMKwtxykTN44dbGdG_TN8Kw7dsGDDyiX7Hpdu3ULoOSU1JXT36lBPMU9zzQjlNWU14fQBuqRC7CretfThVjdtJVhLL9CTlA6EsH5H-GN0wRreNpyRS_RzH_y3KkOcsQnOhftqXbAy5QKrHK1y2NghWudUtsFjNZwL6_FSKvA54XubJ2znRdkII3ZgMr4rD9Hq1amI0zHl4KzGZvV6g1_j2wk2IMSsvAYcDI7TsXjByo84qgxYh_JBcE_RI6Ncgmfn8wp9ff_u9uZjtf_84dPN9b7SDW1y1eueGWZ600CvdgMzlBndD-3YjSBM33VciUERwotxzXlDOjEIPfaCCm3ECPwKvTz9u8TwY4WU5WyThmLbQ1iTpILQjouCFyk_SXUMKUUwcol2VvEoKZFbMPIgfwcjt2AkZbIEU6gX5wbrMMP4l_mTRBG8OQmg2LyzEGXSZbwaxjJVneUY7H8avP2H1856q5X7DkdIh7BGXyYoqUwFkF-23dhWg3JCm7bn_Bcnr7k3</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Nedios, Sotirios, MD</creator><creator>Sommer, Philipp, MD, FHRS</creator><creator>Dagres, Nikolaos, MD</creator><creator>Kosiuk, Jedrzej, MD</creator><creator>Arya, Arash, MD</creator><creator>Richter, Sergio, MD</creator><creator>Gaspar, Thomas, MD</creator><creator>Kanagkinis, Nikolaos, MD</creator><creator>Dinov, Borislav, MD</creator><creator>Piorkowski, Christopher, MD</creator><creator>Bollmann, Andreas, MD, PhD</creator><creator>Hindricks, Gerhard, MD, FHRS</creator><creator>Rolf, Sascha, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control</title><author>Nedios, Sotirios, MD ; Sommer, Philipp, MD, FHRS ; Dagres, Nikolaos, MD ; Kosiuk, Jedrzej, MD ; Arya, Arash, MD ; Richter, Sergio, MD ; Gaspar, Thomas, MD ; Kanagkinis, Nikolaos, MD ; Dinov, Borislav, MD ; Piorkowski, Christopher, MD ; Bollmann, Andreas, MD, PhD ; Hindricks, Gerhard, MD, FHRS ; Rolf, Sascha, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-9c92f2f9f4e9a6b2f12fc9b7d8de5f9883a5ba003243c334085b5cd9515cf5de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiovascular</topic><topic>Case-Control Studies</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - methods</topic><topic>Echocardiography</topic><topic>Electrocardiography</topic><topic>Electrocardiography, Ambulatory</topic><topic>Follow-Up Studies</topic><topic>Heart failure</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Left ventricular dysfunction</topic><topic>Middle Aged</topic><topic>Pulmonary Veins - surgery</topic><topic>Systole</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Left - complications</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Dysfunction, Left - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nedios, Sotirios, MD</creatorcontrib><creatorcontrib>Sommer, Philipp, MD, FHRS</creatorcontrib><creatorcontrib>Dagres, Nikolaos, MD</creatorcontrib><creatorcontrib>Kosiuk, Jedrzej, MD</creatorcontrib><creatorcontrib>Arya, Arash, MD</creatorcontrib><creatorcontrib>Richter, Sergio, MD</creatorcontrib><creatorcontrib>Gaspar, Thomas, MD</creatorcontrib><creatorcontrib>Kanagkinis, Nikolaos, MD</creatorcontrib><creatorcontrib>Dinov, Borislav, MD</creatorcontrib><creatorcontrib>Piorkowski, Christopher, MD</creatorcontrib><creatorcontrib>Bollmann, Andreas, MD, PhD</creatorcontrib><creatorcontrib>Hindricks, Gerhard, MD, FHRS</creatorcontrib><creatorcontrib>Rolf, Sascha, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nedios, Sotirios, MD</au><au>Sommer, Philipp, MD, FHRS</au><au>Dagres, Nikolaos, MD</au><au>Kosiuk, Jedrzej, MD</au><au>Arya, Arash, MD</au><au>Richter, Sergio, MD</au><au>Gaspar, Thomas, MD</au><au>Kanagkinis, Nikolaos, MD</au><au>Dinov, Borislav, MD</au><au>Piorkowski, Christopher, MD</au><au>Bollmann, Andreas, MD, PhD</au><au>Hindricks, Gerhard, MD, FHRS</au><au>Rolf, Sascha, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>11</volume><issue>3</issue><spage>344</spage><epage>351</epage><pages>344-351</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24374320</pmid><doi>10.1016/j.hrthm.2013.12.031</doi><tpages>8</tpages></addata></record> |
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| ispartof | Heart rhythm, 2014-03, Vol.11 (3), p.344-351 |
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| subjects | Atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Cardiovascular Case-Control Studies Catheter ablation Catheter Ablation - methods Echocardiography Electrocardiography Electrocardiography, Ambulatory Follow-Up Studies Heart failure Heart Rate - physiology Humans Left ventricular dysfunction Middle Aged Pulmonary Veins - surgery Systole Treatment Outcome Ventricular Dysfunction, Left - complications Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Left - surgery |
| title | Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control |
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