Treatment with catheter ablation for patients with arrhythmia-induced cardiomyopathy caused by atrial fibrillation promises a good prognosis

• Published in: Heart and vessels Vol. 39; no. 3; pp. 240 - 251
• Main Authors: Aoyama, Daisetsu, Miyazaki, Shinsuke, Amaya, Naoki, Tama, Naoto, Hasegawa, Kanae, Nomura, Ryohei, Tsuji, Toshihiko, Nakano, Akira, Uzui, Hiroyasu, Tada, Hiroshi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-03-2024; Springer Nature B.V
• Subjects: Ablation; Angiotensin; Arrhythmia; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cardiomyopathies - complications; Cardiomyopathies - diagnosis; Cardiomyopathy; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Clinical outcomes; Congestive heart failure; Drug therapy; Fibrillation; Heart failure; Heart Failure - physiopathology; Humans; Inhibitors; Male; Medical instruments; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Patients; Prognosis; Radiofrequency ablation; Renin; Research ethics; Stroke Volume; Treatment Outcome; UMIN; UMIN000050391; Vascular Surgery; Ventricle; Ventricular Dysfunction, Left - etiology; Ventricular Function, Left; Heart failure with recovered ejection fraction; Catheter ablation; Atrial fibrillation; Arrhythmia-induced cardiomyopathy
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-023-02329-7

Clinical outcomes after catheter ablation in patients with reduced left ventricular (LV) ejection fraction (EF) and atrial fibrillation (AF) remain unclear. This study aimed to explore the clinical outcomes of patients with arrhythmia-induced cardiomyopathy (AIC) and the influence of pharmacological treatment on clinical outcomes in patients with AIC after the procedure. Ninety-six patients with AF with a reduced LVEF (LVEF < 50%, 66.7 ± 10.9 years; 72 males) underwent AF ablation. AIC was defined as patients whose LVEF recovered ≥ 50% after catheter ablation (
n
 = 67) and patients whose LVEF remained reduced were defined as non-AIC (
n
 = 29). During a median follow-up of 25 (13–40) months, Kaplan–Meier analysis demonstrated that patients with AIC were associated with less frequent cardiovascular death (
p
 = 0.025) and hospitalization for worsening heart failure (
p
 < 0.001) than those without AIC. Freedom from AF recurrence was similar between the two groups (
p
 = 0.47). In multivariate analysis, the LV end-diastolic diameter (
p
 = 0.0002) and the CHA
2
DS
2
-VASc scores (
p
 = 0.0062) were independent predictors of AIC. Among the 67 patients with AIC, no significant differences in baseline characteristics, except for LV chamber size and cryoballoon use, were observed between patients with AIC with (
n
 = 31) and without renin–angiotensin system (RAS) inhibitors (
n
 = 36). In the Kaplan–Meier analysis, cardiovascular death, hospitalization for worsening heart failure, and AF recurrence after catheter ablation did not differ between patients treated with and without RAS inhibitors (all
p
 > 0.05). Catheter ablation in patients with AIC due to AF is associated with a good post-procedural prognosis.
IRB information
The study was approved by the Research Ethics Committee of the University of Fukui (No. 20220151) and clinical trial registration (UMIN000050391).