TY - JOUR
T1 - Long-term outcomes of catheter ablation of atrial fibrillation in dilated cardiomyopathy
AU - Zhao, Liang
AU - Xu, Kai
AU - Jiang, Weifeng
AU - Zhou, Li
AU - Wang, Yuanlong
AU - Zhang, Xiaodong
AU - Wu, Shaohui
AU - Liu, Xu
N1 - Publisher Copyright:
© 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Objective: The long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously. Methods and results: Forty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45 months (range, 36-64 months) for multiple procedures (mean, 1.9 ± 0.8 [1-4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42-38.34]; P = 0.017) and larger left ventricular end-diastolic diameter (OR, 1.24 [95% CI, 1.01-1.52]; P = 0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during longterm follow-up compared with pre-ablation, but this improvement was not sustained beyond 3 years. Conclusion: Inpatients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3 years post ablation.
AB - Objective: The long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously. Methods and results: Forty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45 months (range, 36-64 months) for multiple procedures (mean, 1.9 ± 0.8 [1-4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42-38.34]; P = 0.017) and larger left ventricular end-diastolic diameter (OR, 1.24 [95% CI, 1.01-1.52]; P = 0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during longterm follow-up compared with pre-ablation, but this improvement was not sustained beyond 3 years. Conclusion: Inpatients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3 years post ablation.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Dilated cardiomyopathy
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U2 - 10.1016/j.ijcard.2015.04.186
DO - 10.1016/j.ijcard.2015.04.186
M3 - Article
C2 - 25920033
AN - SCOPUS:84929152244
SN - 0167-5273
VL - 190
SP - 227
EP - 232
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 1
ER -