Catheter ablation of atrial fibrillation versus antiarrhythmic therapy in patients with left ventricular systolic dysfunction

Aim. To evaluate the efficacy of catheter ablation (CA) of atrial fibrillation (AF) in patients with left ventricular systolic dysfunction and the effect of the procedure on the course of chronic heart failure (CHF) compared with the use of antiarrhythmic therapy (AAT).

Materials and methods. The study included patients (n=80) with left ventricular ejection fraction (LVEF) less than 50% and AF, who were divided into 2 groups: the first group (n=40) underwent CA, the second group included patients on AAT. At baseline and after 6 months of follow-up, transthoracic echocardiography, determination of NT-proBNP concentration, 6-minute walk test and The Minnesota Living With Heart Failure Questionnaire were performed.

Results. After 6 months of follow-up, the absence of documented AF paroxysms was observed in 80% in the CA group versus 45% in the AAT group (p=0,001). A significant increase in LV EF was revealed in both groups, however, in CA group it was more significant (57% [50,5; 60] in the CA group versus 46% [40; 50] in the AAT group (p=0,0001)). There was a decrease in the left ventricle ESD and the left atrial size and volume in the CA group, while in the AAT group the dynamics of these parameters did not change within six months (p=0.0001). An improvement in the clinical course of CHF was observed in both groups: the level of NT-proBNP was 196,6 [116,5; 327,1] pg/ml and 540.5 [382,8; 861,2] pg/ml (0,0001), the 6-minute walk distance increased to 470 m [400; 500] and 368 [330; 400] m (p=0,0001), respectively, the improvement of the functional class (1,15±0,67 and 2,05±0,55 (p=0,0001)) and the quality of life (p=0,0001) were observed.

Conclusion. CA is an effective method for patients with AF and CHF. The use of CA in patients with CHF promotes reverse remodeling, a decrease in the level of NT-proBNP, as well as an improvement in the quality of life and an increase in exercise tolerance.

1. Balla С., Cappato R. Atrial fibrillation ablation in heart failure. Eur Heart J Suppl. 2020;22(Suppl E):E50-E53. https://doi.org/10.1093/eurheartj/suaa059

2. Santhanakrishnan R., Wang N., Larson,M. G., et al. Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction Circulation. 2016;133(5):484-492. https://doi.org/10.1161/CIRCULATIONAHA.115.018614

3. Hindricks G., Potpara T., Dagres N., et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for Cardio-Thoracic surgery (EACTS). Eur Heart J. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612

4. Kirchhof P., Camm A.J., Goette A., et al. EAST-AFNET 4 Trial Investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383(14):1305-1316. https://doi.org/10.1056/NEJMoa2019422

5. Rillig A., Magnussen C., Ozga A.K., et al. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation. Circulation. 2021;144(11):845-858. https://doi.org/10.1161/CIRCULATIONAHA.121.056323

6. Ardus D.F., Uskach T.M., Sapelnikov O.V., Tereshchenko S.N., Akchurin R.S. Interventional Treatment of Atrial Fibrillation in Patients with Heart Failure: Pros and Cons. Lechebnoe delo, 2022 (1), 84-88 (in Russ.)]. https://doi.org/10.24412/2071-5315-2022-12483

7. Kotecha D., Piccini J.P. Atrial fibrillation in heart failure: what should we do? Eur Heart J. 2015;36(46):3250-3257. https://doi.org/10.1093/eurheartj/ehv513

8. Gopinathannair R., Chen L.Y., Chung M.K., et al. Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association Circ Arrhythm Electrophysiol. 2021 Nov;14(11):e000080. https://doi.org/10.1161/HAE.0000000000000078

9. Di Biase L., Mohanty P., Mohanty S., et al. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial. Circulation. Circulation. 2016;133(17):1637-1644. https://doi.org/10.1161/CIRCULATIONAHA.115.019406

10. Hunter R.J., Berriman T.J., Diab I., et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014;7(1):31-38. https://doi.org/10.1161/CIRCEP.113.000806

11. Shah S.R., Moosa P.G., Fatima M., et al. Atrial fibrillation and heart failureresults of the CASTLE-AF trial. J Community Hosp Intern Med Perspect. 2018;8(4):208-210. https://doi.org/10.1080/20009666.2018.1495979

12. Packer D.L., Piccini J.P., Monahan K.H. et al. Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial. Circulation. 2021;143(14):1377-1390. https://doi.org/10.1161/CIRCULATIONAHA.120.05099

13. Seliutskii SI, Savina NM, Chapurnykh AV. The effectiveness of radiofrequency ablation and repeated cardioversion in combination with antiarrhythmic drug therapy in maintaining stable sinus rhythm in patients with atrial fibrillation and heart failure. Kardiologiia. 2020;60(8):90-97 (In Russ.)]. https://doi.org/10.18087/cardio.2020.8.n916

14. Magnocavallo M., Parlavecchio A., Vetta G., et al. Catheter Ablation versus Medical Therapy of Atrial Fibrillation in Patients with Heart Failure: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2022;11(19):5530. https://doi.org/10.3390/jcm11195530