scholarly journals The effectiveness of radiofrequency ablation and repeated cardioversion in combination with antiarrhythmic drug therapy in maintaining stable sinus rhythm in patients with atrial fibrillation and heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 90-97
Author(s):  
S. I. Seliutskii ◽  
N. M. Savina ◽  
A. V. Chapurnykh
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sf 36 ◽  
Electrocardiogram Monitoring ◽  
Stable Sinus Rhythm

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40–49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.

P421Efficacy of radiofrequency ablation and drug therapy of atrial fibrillation in patients with heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Seliutskii ◽  
N Savina ◽  
A Chapurnykh
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Radiofrequency Ablation ◽  
Therapy Group ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sf 36

Abstract Objective to compare the efficacy of radiofrequency ablation (RFA) and drug therapy in patients with atrial fibrillation (AFib) and heart failure (HF) within 12-month follow-up. Materials and methods 130 patients (men-75%, average age-62.8 ± 11.8 years) with AFib and HF with left ventricular ejection fraction (LVEF)&lt;50% were included in a prospective study. In 107 (82%) of the included patients, intermediate LVEF was detected (40-49%). At the time of inclusion, paroxysmal AFib (PaAFib) was recorded in 60 (46%) of patients and persistent AFib (PeAFib) in 70 (54%). AFib RFA was performed in 65 patients, 65 patients continued to receive optimal antiarrhythmic therapy. Prior to the intervention and after 12 months, all patients underwent transthoracic echocardiography and quality of life (QoL) assessment using the SF-36 questionnaire. Results the freedom from AFib within 12 months follow-up period was registred in 49 (75%) of patients in the RFA group and 26 (40%) in the drug therapy group. After 12 month follow-up period we revealed increase of LVEF (p &lt; 0.001), decrease of anteroposterior size (p &lt;0.001) and volume (p &lt; 0.001) of left atrium (LA), improvement of mental (p = 0.008) and physical (p = 0.048) health components according to the SF-36 questionnaire in the RFA group. In the group of drug rhythm control, after 12 months there was only the improvement of mental (p = 0.006) and physical p = 0.016) health components and it was much less than in RFA group (р&lt;0.001). Similar results were received in patients who were free from Afib within 12 months in both groups. Conclusions in patients with AFib and HF with LVEF &lt; 50%, restoration and maintenance of sinus rhythm using RFA was accompanied by an increase in LVEF, decrease of  LA size, and an improvement of QoL. In the group of drug therapy, there was a lower freedom from AFib and there was the slight improvement only in QoL.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

scholarly journals PREDICTORS OF ATRIAL FIBRILLATION RECURRENCE AFTER RADIOFREQUENCY ABLATION IN PATIENTS WITH CHRONIC HEART FAILURE

2021 ◽  
Vol 74 (8) ◽  
pp. 1850-1855
Author(s):  
Tetiana V. Zolotarova ◽  
Mariia S. Brynza ◽  
Dmytro Y. Volkov ◽  
Maryna I. Shevchuk ◽  
Oleksandr V. Bilchenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Fibrillation Recurrence ◽  
Ventricular Ejection Fraction ◽  
Recurrence Group ◽  
Af Recurrence

The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.

scholarly journals Radiofrequency Ablation Impact on the Morpho-Functional State of the Heart in Patients with Atrial Fibrillation and Chronic Heart Failure

2021 ◽  
Vol 6 (5) ◽  
pp. 169-177
Author(s):  
T. V. Zolotarova ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Functional State ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

The purpose of the study was to evaluate the radiofrequency ablation impact on the morpho-functional state of the heart in patients with atrial fibrillation and chronic heart failure with preserved ejection fraction based on 2-year follow-up. Materials and methods. The study included 194 patients with an average age of 59.3±8.5 years with atrial fibrillation and concomitant heart failure with preserved left ventricular ejection fraction of I-III functional class of New York Heart Association. Patients were divided into 2 groups: 136 patients who underwent radiofrequency catheter ablation and 58 patients in the control group who did not undergo intervention and continued antiarrhythmic pharmacotherapy. Patients were comparable in terms of basic clinical and demographic indicators. In order to assess the morpho-functional state of the heart, transthoracic echocardiography was performed at the stage of inclusion in the study and 2 years after. Results and discussion. According to the results of the analysis in the radiofrequency catheter ablation group 2 years after the intervention revealed: a statistically significant decrease in the mean end-systolic diameter of the left ventricle (3.3±0.48 cm versus 3.2±0.41cm, p <0.001); decreased size of the left atrium (4.3±0.71 cm versus 4.2±0.30 cm, p <0.001); left ventricular ejection fraction increased significantly (61.9±7.14% versus 63.9±5.65%, p <0.001); the E/e' ratio decreased statistically significantly (11.9±1.65 versus 9.4±1.48; p <0.001) and the left ventricular myocardial mass index (118.3±25.04 g/m2 versus 116.4±18.04 g/m2; p=0.045). In the pharmacotherapy group there were: a statistically significant increase in the average end-systolic size of the left ventricle (3.61±0.45 cm versus 3.63±0.41, p=0.007); statistically significant increased left atrium (4.3±0.61 cm versus 4.4±0.36; p <0.001) and the right atrium (4.1±0.52 cm versus 4.2±0.26; p <0.001); decreased left ventricular ejection fraction (58.1±6.12% versus 56.6±6.11; p <0.001); increased values of the ratio E/e' (12.1±1.63 versus 12.7±1.27; p=0.002) and decreased level of the left ventricular myocardial mass index (120.5±24.05 g/m2 versus 118.3±20.13 g/m2; p=0.044). Conclusion. Radiofrequency ablation of atrial fibrillation in patients with heart failure with preserved left ventricular ejection fraction to control sinus rhythm is associated with improved morpho-functional state of the heart at the 2-year follow-up compared with antiarrhythmic pharmacotherapy strategy: the left ventricular ejection fraction increases, the left ventricular diastolic function improves according to the E/e' value, the size of the left atrium decreases

scholarly journals Antiarrhythmic drugs in patients with early persistent atrial fibrillation and heart failure: results of the RACE 3 study

EP Europace ◽  
2021 ◽  
Author(s):  
Meelad I H Al-Jazairi ◽  
Bao-Oanh Nguyen ◽  
Ruben R De With ◽  
Marcelle D Smit ◽  
Bob Weijs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drugs ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular ◽  
Class I ◽  
Left Ventricular Ejection ◽  
Converting Enzyme Inhibitors ◽  
Ventricular Ejection Fraction

Abstract Aims Maintaining sinus rhythm in patients with persistent atrial fibrillation (AF) is challenging. We explored the efficacy of class I and III antiarrhythmic drugs (AADs) in patients with persistent AF and mild to moderate heart failure (HF). Methods and results In the RACE 3 trial, patients with early persistent symptomatic AF and short history of mild to moderate HF with preserved or reduced left ventricular ejection fraction (LVEF) were randomized to targeted or conventional therapy. Both groups received AF and HF guideline-driven treatment. Additionally, the targeted-group received mineralocorticoid receptor antagonists, statins, angiotensin-converting enzyme inhibitors and/or receptor blockers, and cardiac rehabilitation. Class I and III AADs could be instituted in case of symptomatic recurrent AF. Eventually, pulmonary vein isolation could be performed. Primary endpoint was sinus rhythm on 7-day Holter after 1-year. Included were 245 patients, age 65 ± 9 years, 193 (79%) men, AF history was 3 (2–6) months, HF history 2 (1–4) months, 72 (29.4%) had HF with reduced LVEF. After baseline electrical cardioversion (ECV), 190 (77.6%) had AF recurrences; 108 (56.8%) received class I/III AADs; 19 (17.6%) flecainide, 36 (33.3%) sotalol, 3 (2.8%) dronedarone, 50 (46.3%) amiodarone. At 1-year 73 of 108 (68.0%) patients were in sinus rhythm, 44 (40.7%) without new AF recurrences. Maintenance of sinus rhythm was significantly better with amiodarone [n = 29/50 (58%)] compared with flecainide [n = 6/19 (32%)] and sotalol/dronedarone [n = 9/39 (23%)], P = 0.0064. Adverse events occurred in 27 (25.0%) patients, were all minor and reversible. Conclusion In stable HF patients with early persistent AF, AAD treatment was effective in nearly half of patients, with no serious adverse effects reported.

Predictive value of atrial fibrillation catheter ablation on cognitive functions in patients with chronic heart failure

2021 ◽  
Vol 42 (2) ◽  
pp. 75-81
Author(s):  
T. V. Zolotarova ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Cognitive Functions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Atrial fibrillation (AF) directly leads to a cognitive function decline regardless of the cerebrovascular fatal events, but it is unclear whether the sinus rhythm restoration and reducing the AF burden can reduce the rate of this decreasement. Data on the effect of radiofrequency ablation on patients’ cognitive functions are conflicting and need to be studied. The aim of the study was to evaluate the prognostic value of atrial fibrillation radiofrequency catheter ablation on cognitive functions in patients with chronic heart failure with preserved left ventricular ejection fraction. The impact of AF radiofrequency catheter ablation on cognitive function in 136 patients (mean age 59.7 ± 8.6 years) with chronic heart failure with preserved left ventricular ejection fraction and compared with 58 patients in the control group (58.2 ± 8.1 years), which did not perform ablation and continued the tactics of drug antiarrhythmic therapy was investigated. Cognitive function was assessed using the Montreal Cognitive Test (MoCA) at the enrollment stage and 2 years follow-up. Decreased cognitive function was defined as a MoCA test score < 26 points, cognitive impairment < 23 points. Two years after the intervention, there was a positive dynamics (baseline MoCA test — 25,1 ± 2,48, 2-year follow-up — 26,51 ± 2,33, p < 0,001) in the ablation group and negative in the control group (25,47 ± 2,85 and 24,57 ± 3,61, respectively, p < 0,001). Pre-ablation cognitive impairment was significantly associated with improved cognitive function 2 years after AF ablation according to polynomial regression analysis. The obtained data suggest a probable positive effect of AF radiofrequency ablation on cognitive functions in patients with preserved left ventricular ejection fraction.

scholarly journals Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

2021 ◽  
Vol 26 (1) ◽  
pp. 4200
Author(s):  
I. V. Zhirov ◽  
N. V. Safronova ◽  
Yu. F. Osmolovskaya ◽  
S. N. Тereschenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Number Of Patients ◽  
Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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