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CLINICAL RESEARCH: ATRIAL FIBRILLATION

Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function

^* Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received April 28, 2003; revised manuscript received August 25, 2003, accepted September 8, 2003.

^* Reprint requests and correspondence: Dr. Andrea Natale, Co-Section Head of Pacing and Electrophysiology, Director, Electrophysiology Laboratory, Medical Director, Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F-15, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
natalea{at}ccf.org

This study was presented as an abstract during the annual meeting of the American College of Cardiology, Atlanta, Georgia, March 2002.

OBJECTIVES: We aimed to determine the safety and efficacy of pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients with impaired left ventricular (LV) systolic function.

BACKGROUND: To date, PVI has been performed primarily in patients with normal LV function. Yet, many AF patients have impaired LV systolic function. The outcomes of PVI in patients with impaired LV systolic function are unknown.

METHODS: We included 377 consecutive patients undergoing PVI between December 2000 and January 2003. Ninety-four patients had impaired LV function (ejection fraction [EF] <40%), and they comprised the study group. The control group was the remaining 283 patients who had a normal EF. End points included AF recurrence and changes in EF and quality of life (QoL).

RESULTS: Mean EF was 36% in our study group, compared with 54% in controls. After initial PVI, 73% of patients with impaired EF and 87% of patients with normal EF were free of AF recurrence at 14 ± 6 months (p = 0.03). In the study group, there was a nonsignificant increase in EF of 4.6% and significant improvement in QoL. Complication rates were low and included a 1% risk of pulmonary vein stenosis.

CONCLUSIONS: Although the AF recurrence rate after initial PVI in impaired EF patients was higher than in normal EF subjects, nearly three-fourths of patients with impaired EF remained AF-free. Although our sample size was nonrandomized, our results suggest PVI may be a feasible therapeutic option in AF patients with impaired EF. Randomized studies with more patients and longer follow-up are warranted.

Abbreviations and Acronyms   AF = atrial fibrillation   CHF = congestive heart failure   EF = ejection fraction   ICE = intracardiac echocardiogram   LV = left ventricular/ventricle   NYHA = New York Heart Association   PV = pulmonary vein   PVI = pulmonary vein isolation   QoL = quality of life   SF-36 = 36-Item Short-Form Health Survey

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