CORRESPONDING AUTHOR
Laure Champ-Rigot, Normandie Univ, UNICAEN, CHU de Caen Normandie,
Service de Cardiologie, 14000 Caen, France
Tel: +33231065118
Fax: +33231064418
E-mail:champrigot-l@chu-caen.fr
Conflict of interest statement : Authors have no conflict to disclose
ABSTRACT
Introduction: Catheter ablation of atrial fibrillation (AF)
and/or atrial tachycardia (AT) in heart failure (HF) patients provides
improvement in symptoms cardiac function and survival. However, these
procedures remain challenging with higher recurrence and complication
rates compared to patients with normal cardiac function. We aimed to
compare outcomes of AF/AT ablations guided by an ultra-high density
mapping system between HF patients and controls.
Methods and results: Primary endpoint was the one-year
recurrence rate of AF/AT. We retrospectively examined all
Rhythmia™-guided procedures performed in Caen and Toulouse University
Hospitals between 2015 and 2018 for AF/AT. Patients with reduced left
ventricular ejection fraction (LVEF) (i.e. <50%), or with
preserved LVEF and signs/symptoms of HF were constituted the HF group
and were subsequently classified in two subgroups of HF patients with
preserved (HFpEF) or reduced/mildly reduced (HFrEF) LVEF. 246 patients
were included, 135 in the HF group. At one-year, 71 patients had
experienced AF/AT recurrences, with no difference between HF group
versus non-HF group (31.9 vs 25.2% respectively, p=0.262). AF/AT
recurrence rates were not different between HFpEF and HFrEF subgroups
(37.1 vs 26.4% respectively, p=0.196). In multivariate analysis,
patients with mitral regurgitation (p=0.011), hypertrophic
cardiomyopathy (p=0.011) and persistent AF (p=0.02) were at higher risk
of recurrence. AF/AT recurrence was not significantly associated with HF
hospitalization (p=0.078) but HF status was the only independent
predictive factor of HF hospitalization (p=0.002). Patients in the HF
group showed significant improvement in both their NYHA class and LVEF
than non-HF patients. After ablation procedures, while patients with
HFrEF and HFpEF showed similar NYHA class improvement, LVEF only
improved in HFrEF patients. The rate of complications were comparable in
both groups.
Conclusion: Clinical outcomes of AF/AT ablations guided by UHD
mapping system appear similar in HF and non-HF patients. During the
follow-up period, patients with HF exhibit improvement of NYHA status
and LVEF.
Key Words: atrial arrhythmia, heart failure, catheter ablation,
clinical outcomes, electroanatomic mapping system