Structured Abstract
Background :
Although catheter ablation (CA) is an effective treatment for patients
with AF and LVSD, the efficacy of an initial cryo-ablation strategy is
unknown. This study evaluated long term outcomes of patients with an
initial cryo-ablation strategy for AF and LV systolic dysfunction
(LVSD).
Methods :
Outcomes of patients undergoing index cryoablation for AF from January
2008 until March 2018, with documented pre-ablation LVEF≤45% were
evaluated for long term freedom from AF and change in ventricular
function from baseline.
Results :
76 patients met inclusion criteria. Patients were predominantly male
(80%), aged 63 ±11yrs, with an average CHADS2 VASc
score of 2.66 ± 1.40, baseline LVEF 34 ± 8.7% (ischaemic in 37%) and
NYHA class 2.37 ± 0.72. Repeat procedures were performed in 13%. The
single procedure success was 70% at 1 year (81% for paroxysmal AF,
65% for persistent AF, 29% for long-standing persistent AF) and at 28
± 13 months follow up was 43% (50%, 41% and 21% respectively),
increasing to 59% allowing for subsequent redo procedure with RF
ablation (64%, 57%, and 50% respectively). At follow up, LVEF
significantly improved to 46 ± 16% (p<0.001), and NYHA
reduced to 1.51 ± 0.66 (p<0.001).
Conclusion :
An initial strategy of cryoablation in patients with AF and LVSD is an
effective approach in the treatment of patients with concurrent AF and
LVSD. Larger, randomised prospective studies are required to confirm
these findings.