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Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE.

ABSTRACT: Heart failure (HF) and AF frequently coexist and are involved in a vicious cycle of adverse pathophysiologic interactions. Applying treatment algorithms that have been validated in the general AF population to patients with AF and HF may be fraught with risks and lack effectiveness. While firm recommendations on using catheter ablation for AF do exist, the subset of patients also suffering from HF needs to be further evaluated. Observational data indicate that a significant number of ablation procedures are performed in patients with coexistent HF. Initial randomised data on outcomes are encouraging. Apart from sinus rhythm maintenance, benefits have been observed in terms of other significant endpoints, including left ventricular ejection fraction, quality of life, exercise capacity and hospital readmissions for HF. Limited existing data on survival are also promising. In the present article, observational and randomised studies along with current practice guidelines are summarised.

SUBMITTER: Vrachatis D

PROVIDER: S-EPMC6304798 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE.

Vrachatis Dimitrios D Deftereos Spyridon S Kekeris Vasileios V Tsoukala Styliani S Giannopoulos Georgios G

Arrhythmia & electrophysiology review 20181201 4

Heart failure (HF) and AF frequently coexist and are involved in a vicious cycle of adverse pathophysiologic interactions. Applying treatment algorithms that have been validated in the general AF population to patients with AF and HF may be fraught with risks and lack effectiveness. While firm recommendations on using catheter ablation for AF do exist, the subset of patients also suffering from HF needs to be further evaluated. Observational data indicate that a significant number of ablation pr ...[more]

PMID: 30588315

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Project description:BackgroundManaging patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF.MethodsAF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison.ResultsAmong 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415-4.449, p = 0.002) and with the respective rates predicted by risk scores.ConclusionsCombining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort.

Dataset Information

Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE.

Publications

Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE.

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