Catheter ablation (CA) is an effective way to restore sinus rhythm and reverse left ventricular systolic dysfunction (LVSD) in patients with persistent atrial fibrillation (AFib), according to new research.
In a small, randomized study, patients undergoing CA improved left ventricular ejection fraction (LVEF) by 18 percent at six months compared to 4.4 percent in patients receiving medical rate control (MRC). The CA group also showed greater reductions in ventricular and atrial size and New York Heart Association functional class.
Sandeep Prabhu, MBBS, from the Baker Heart & Diabetes Institute in Melbourne, Australia, and colleagues plan to publish their findings in the Journal of the American College of Cardiology.
Half of the 66-patient trial population was enrolled in each type of treatment. The average baseline LVEF was 33 percent. At six months, 58 percent of patients undergoing CA showed normalized systolic function—LVEF of at least 50 percent—compared to 9 percent in the MRC group.
“These findings indicate that in these patients, AF (AFib) may either significantly contribute to, or indeed be entirely responsible for LVSD,” Prabhu and colleagues wrote. “Catheter ablation in conjunction with cardiac MR should be considered in patients with persistent AFib and otherwise unexplained systolic dysfunction. These findings challenge the current treatment paradigm that rate control is adequate in AFib and heart failure.”
To build on their research, the authors suggested longer-term, randomized studies analyzing hospitalizations and mortality in this patient population.