Catheter ablation of atrial fibrillation in patients with concomitant left ventricular impairment: A systematic review of efficacy and effect on ejection fraction

Anand N. Ganesan, Savvy Nandal, Jakob Lüker, Rajeev K. Pathak, Rajiv Mahajan, Darragh Twomey, Dennis H. Lau, Prashanthan Sanders

Research output: Contribution to journalArticlepeer-review

48 Citations (Scopus)

Abstract

Introduction: Catheter ablation of atrial fibrillation (AF) is an established rhythm control strategy; however, the impact of co-existing LV systolic dysfunction (LVSD) on ablation success is less well understood. This systematic review compiles the outcomes of catheter ablation of atrial fibrillation in patients with LVSD. Methods: An electronic database (Pubmed, Scopus, Embase) search using the keywords 'atrial fibrillation AND ablation AND (ventricular dysfunction OR heart failure OR cardiomyopathy)' was performed for English scientific literature up to 01/01/2014. 2484 references were retrieved and evaluated for relevance by three reviewers. Reviews and reference lists of retrieved articles were also examined to ensure all relevant studies were included. Data was extracted from 19 studies, including a total of 914 patients. Results: Single-procedure success in LVSD patients for AF ablation was 56.5% (95% CI: 48%-64%). Overall multiple-procedure (including the use of anti-arrhythmic drugs) in LVSD patients for AF ablation was 81.8% (95% CI: 75%-87%). The mean increase in LVEF following AF ablation was 13.3% (95% CI: 10.8%-15.9%). Seven studies reported improvements in exercise capacity and quality of life information using standardised criteria. The pooled rate of serious adverse events was 5.5% (95% CI: 3.7%-8.1%). Conclusions: Catheter ablation may be an effective therapy in AF patients with left ventricular systolic impairment, and can be associated with improvements in left ventricular function, quality of life, exercise capacity, and modest rates of serious adverse events.

Original languageEnglish
Pages (from-to)270-280
Number of pages11
JournalHeart Lung and Circulation
Volume24
Issue number3
DOIs
Publication statusPublished or Issued - 1 Mar 2015

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Heart failure
  • Rhythm control
  • Systematic review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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