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Ablation therapy in heart failure
Zbigniew Kalarus
Department of Cardiology, Congenital Heart Diseases and Electrotherapy
Silesian Center for Heart Diseases, Medical University of Silesia
Zabrze, Poland
Catheter ablation for atrial fibrillation
Catheter ablation for atrial fibrillation is a well established and effective
therapeutic option in patients without CHF
ESC recommendations for left atrial ablation
Heart Failure and Atrial Fibrillation
 Congestive heart failure and atrial fibrillation
are the two major „epidemics” of cardiovascular
disease
 HF triggering the development of AF and vice versa
 Both of them increase the morbidity and mortality in
a synergistic manner
What is the Role and Place of Catheter
Ablation for Atrial Fibrillation Treatment
in Congestive Heart Failure?
 Limited data on the impact of AF ablation on:
quality of life, left ventricular function, exercise
capacity and mortality
 The effects of ablation for atrial fibrillation in
HF patients is still uncertain
Catheter Ablation for Atrial Fibrillation
in Congestive Heart Failure
Hsu et al.: NEJM 2004; 351:2373-2383
Catheter Ablation for Atrial Fibrillation
in Congestive Heart Failure
Hsu et al.: NEJM 2004; 351:2373-2383
Catheter Ablation for Atrial Fibrillation
in Congestive Heart Failure
Hsu L-F. NEJM 2004
Catheter Ablation for Atrial Fibrillation
in Congestive Heart Failure
86%
54%
Hsu et al.: NEJM 2004; 351:2373-2383
Pulmonary Vein Isolation for theTreatment
of AF in Patients with Impaired LV Systolic Function
Chen MS. JACC 2004
Pulmonary Vein Isolation for the Treatment
of AF in Patients with Impaired LV Systolic Function
Chen MS. JACC 2004
Pulmonary Vein Isolation for the Treatment
of AF in Patients with Impaired LV Systolic Function
Chen MS. JACC 2004
Pulmonary Vein Isolation for the Treatment
of AF in Patients with Impaired LV Systolic Function
Chen MS. JACC 2004
Meta-Analysis of the Effectiveness and Safety of
Catheter Ablation of Atrial Fibrillation in patients
With Versus Without Left Ventricular Systolic
Dysfunction
Wilton S. Am J Cardiol , 2010
Meta-Analysis of the Effectiveness and Safety of
Catheter Ablation of Atrial Fibrillation in patients
With Versus Without Left Ventricular Systolic
Dysfunction
Wilton S. Am J Cardiol, 2010
Meta-Analysis of the Effectiveness and Safety of
Catheter Ablation of Atrial Fibrillation in patients With
Versus Without Left Ventricular Systolic Dysfunction
Wilton S. Am J Cardiol, 2010
Limitations of the existing data
-
broad inclusion criteria, ie. EF<50%
-
small number of recruited patients (<500 pts)
-
lack of the assessment of AF ablation impact
on mortality
Complications of AF catheter ablation
Complications of AF catheter ablation
Summary
1.
The incidence of recurrent AF after PV isolation is higher in
patients with CHF and therefore a repeated procedure is required
more frequently
2.
The maintenance of a sinus rhythm by AF catheter ablation in
patients with CHF seems to improve the following :

LV systolic function

exercise capacity

quality of life
Recommendations for left atrial ablation
Pulmonary-Vein Isolation for Atrial Fibrillation in
Patients with Heart Failure
PABA-HF
Khan MN. NEJM, 2008
Pulmonary-Vein Isolation for Atrial Fibrillation in
Patients with Heart Failure
PABA-HF
Khan MN. NEJM, 2008
Pulmonary-Vein Isolation for Atrial Fibrillation in
Patients with Heart Failure
PABA-HF
Khan MN. NEJM, 2008
Pulmonary-Vein Isolation for Atrial Fibrillation
in Patients with Heart Failure
PABA-HF
Khan MN. NEJM, 2008
Long-term survival in patients undergoing CRT:
the importance of performing A-V junction ablation
in patients with permanent AF
Gasparini, EHJournal 2008
Conclusions
The pursue for the sinus rhythm maintenace by
means of catheter ablation requires an individual
clinical approach based on:
- the stage af atrial diease, including the type of AF
- the presence and severity of uderlying
cardiovascular disease
- potential treatment alternative
- patient’s preference
Conclusions

The ultimate assessment of the role and impact of
AF catheter ablation on clinical outcome in CHF
needs further investigation
Conclusions
a-v node ablation

A-V node ablation seems not to be as effective as
PVI in patients with CHF

It is reasonable to consider a-v node ablation in
CRT patients with permanent AF and suboptimal
percentage of CRT pacing