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SCIENTIFIC STATEMENT:
Prevention of Torsade de Pointes in Hospital Settings
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
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J Am Coll Cardiol, 2004; 43:1004-1009, doi:10.1016/j.jacc.2003.09.056
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ATRIAL FIBRILLATION

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

Michael S. Chen, MD*, Nassir F. Marrouche, MD*, Yaariv Khaykin, MD*, A. Marc Gillinov, MD*, Oussama Wazni, MD*, David O. Martin, MD, MPH*, Antonio Rossillo, MD*, Atul Verma, MD*, Jennifer Cummings, MD*, Demet Erciyes, MD*, Eduardo Saad, MD*, Mandeep Bhargava, MD*, Dianna Bash, RN*, Robert Schweikert, MD*, David Burkhardt, MD*, Michelle Williams-Andrews, RN*, Alejandro Perez-Lugones, MD*, Ahmad Abdul-Karim, MD*, Walid Saliba, MD* and Andrea Natale, MD*,*

* 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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