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

Anand Ganesan, Savvy Nandal, Jakob Luker, Rajeev Pathak, Rajiv Mahajan, Darragh Twomey, Dennis Lau, Prashanthan Sanders

    Research output: Contribution to journalArticle

    40 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 - 2015

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