Catheter ablation of atrial fibrillation in patients with concomitant left ventricular impairment: a systematic review of efficacy and effect on ejection fraction
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.
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Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, but further data are needed.
“Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, 185,[226][227][228] but further data are needed.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [227]
For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.
“For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [227]
The rhythm outcome after catheter ablation of atrial fibrillation is difficult to predict in individual patients.
“The rhythm outcome after catheter ablation of AF is difficult to predict in individual patients.173,227,713,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [227]
Several smaller trials suggest improved left ventricular function after catheter ablation in heart failure with reduced ejection fraction patients.
“Several smaller trials suggest improved LV function after catheter ablation in HFrEF patients 185, 226-228, 778, 779”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [227]
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- Authors
- Ganesan, A. N., Nandal, S., Lüker, J., Pathak, R. K., Mahajan, R., Twomey, D., Lau, D. H., & Sanders, P.
- Affiliations
- Royal Adelaide Hospital (AU)
- Corresponding author
- Sanders, Prashanthan
- ORCID
- Venue
- Heart Lung and Circulation
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 24
- Issue
- 3
- Pages
- 270-280
- ISSN
- 1443-9506 (ISSN-L)
- OpenAlex
- W2154258255
- Cited by
- 73
- References
- 39
- Citations by year
- 2026: 3 · 2025: 2 · 2023: 4 · 2022: 1 · 2021: 7 · 2020: 6 · 2019: 8 · 2018: 15 · 2017: 11 · 2016: 11 · 2015: 5
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Lung and Circulation (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- University of Adelaide
- National Health and Medical Research Council
- National Heart Foundation of Australia
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, catheter ablation, left ventricular systolic dysfunction, left ventricular ejection fraction, ablation success, heart failure, cardiomyopathy, exercise capacity, quality of life, serious adverse events
- MeSH terms
- Atrial Fibrillation, Heart Ventricles, Humans, Stroke Volume, Catheter Ablation, PubMed
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