TY - JOUR
T1 - Different Approaches to Atrial Fibrillation Ablation in Heart Failure Patients
T2 - Temporal Trends and Clinical Outcomes
AU - Bergonti, Marco
AU - Krisai, Philipp
AU - Ascione, Ciro
AU - Pambrun, Thomas
AU - Della Rocca, Domenico G
AU - Compagnucci, Paolo
AU - Özkartal, Tardu
AU - Marcon, Lorenzo
AU - Ferrero, Teba Gonzalez
AU - Pannone, Luigi
AU - Kühne, Michael
AU - Anselmino, Matteo
AU - Casella, Michela
AU - Serban, Teodor
AU - Tondo, Claudio
AU - Rodríguez-Mañero, Moises
AU - Caputo, Maria Luce
AU - Badertscher, Patrick
AU - Derval, Nicolas
AU - de Asmundis, Carlo
AU - Chierchia, Gian Battista
AU - Heidbuchel, Hein
AU - Jaïs, Pierre
AU - Auricchio, Angelo
AU - Sarkozy, Andrea
AU - Conte, Giulio
N1 - Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2025/1/29
Y1 - 2025/1/29
N2 - BACKGROUND: Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.OBJECTIVES: This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.METHODS: Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.RESULTS: A total of 955 HFrEF patients (62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).CONCLUSIONS: Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.
AB - BACKGROUND: Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.OBJECTIVES: This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.METHODS: Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.RESULTS: A total of 955 HFrEF patients (62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).CONCLUSIONS: Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.
UR - http://www.scopus.com/inward/record.url?scp=85218150126&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2024.12.004
DO - 10.1016/j.jacep.2024.12.004
M3 - Article
C2 - 39895449
SN - 2405-500X
JO - JACC. Clinical electrophysiology
JF - JACC. Clinical electrophysiology
ER -