Atrial Fibrillation Ablation – Benefits Beyond Symptom Reduction with a Focus on Patients with Heart Failure with Reduced Ejection Fraction

• Published in: European journal of arrhythmia & electrophysiology 2019-07, Vol.5 (1), p.30
• Main Authors: Guettler, Norbert, Kim Rajappan, Nicol, Edward
• Format: Article
• Language: English
• Subjects: Ablation; Cardiac arrhythmia; Catheters; Ejection fraction; Heart failure
• ISSN: 2058-3869; 2058-3877
• DOI: 10.17925/EJAE.2019.5.1.30

Catheter ablation for atrial fibrillation (AF) has been regarded as a means for symptom control in patients with AF who are resistant to medical therapy. Recommendations in past USA and European guidelines for the management of patients with AF are based on that strategy. However, there are emerging data that catheter ablation for AF may have additional prognostic benefits for patients with AF beyond symptom reduction. Favourable effects of AF ablation on stroke, dementia and other outcomes have been reported. Recently, there has been growing evidence about AF ablation benefits in patients with AF and heart failure with reduced ejection fraction (HFrEF). In this article, seven randomised controlled trials, observational trials, as well as meta-analyses and reviews are described for AF ablation in patients with HFrEF. The results of these trials suggest that AF ablation has beneficial effects on all-cause mortality, hospitalisation for heart failure, improvement of left ventricular ejection fraction, quality of life, and functional capacity. These findings led to additional recommendations in a focused update of the USA guidelines for the management of patients with AF. Data on AF ablation in the subgroups of patients with heart failure with mid-range ejection fraction and preserved ejection fraction, however, are sparse. Robust randomised controlled trials on prognostic benefits of AF ablation in these subgroups are still needed to inform clinical practice.