Abstract
BACKGROUND: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients reduced the mortality but may increase complications and raise the safety concern. HYPOTHESIS: CA for AF in HF patients may not increase the complications vs medical treatment, and it may reduce hospitalizations and mortality and improve heart function. METHODS: Three groups of AF patients were included in the study: 120 congestive HF for their first CA (AFHF-CA), 150 congestive HF who were undergoing medical therapy (AFHF-Med), and 150 patients with normal left ventricular (LV) ejection fraction (LVEF) (AF-CA). RESULTS: After 30 ± 6 months of follow up, 45.8% of patients in the AFHF-CA and 61.3% of patients in the AF-CA groups maintained sinus rhythm (SR) in comparison with 2.7% in AFHF-Med (P < .01). Hospitalization for HF was significantly lower in AFHF-CA than in AFHF-Med groups (P < .01). Death occurred in 7.5% of patients in the AFHF-CA group, which was lower than 18% in the AFHF-Med group (P < .01). Significant improvements in heart function were shown in the AFHF-CA group compared to the AFHF-Med group, including LVEF (P < .01), LV end-diastolic diameter (P < .01), and New York Heart Association classification (P < .01), as well as the left atrial diameter (P < .01). AFHF-CA patients required additional ablation more often (P < .05). CA had a better prognosis in paroxysmal AF and tachycardia-related diseases. CONCLUSION: CA for AF reduced hospitalizations and mortality and improved heart function, vs medical treatment, and was as safe as CA in those with normal heart function.