Safety and efficacy of catheter ablation in atrial fibrillation patients with left ventricular dysfunction

BACKGROUND: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern. HYPOTHESIS: CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function. METHODS: Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF‐CA), 150 congestive HF who were undergoing medical therapy (AFHF‐Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF‐CA). RESULTS: After 30 ± 6 months of follow up, 45.8% of patients in the AFHF‐CA and 61.3% of patients in the AF‐CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF‐Med (P < .01). Hospitalization for HF was significantly lower in AFHF‐CA than in AFHF‐Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF‐CA group, which was lower than 18% in the AFHF‐Med group (P < .01). Significant improvements in heart function were shown in the AFHF‐CA group compared to the AFHF‐Med group, including LVEF (P < .01), LV end‐diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF‐CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia‐related diseases. CONCLUSION: CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.