Introduction

Patients with HFrEF are in the focus of AF ablation programs, since randomized studies have shown that ablation might reduce mortality in this cohort. We aimed to compare procedural characteristics and success rate between patients with HFrEF (≤40%) and those with normal LVEF ≥55% (nEF).

Methods

A total of 291 consecutive patients with recurrent persistent AF who underwent PVI and voltage guided ablation was followed in our AF ablation registry. Only patients who underwent their first ablation were included. Ablation was performed with CARTO3D Mapping system and THERMOCOOL SMARTTOUCH® SF catheter (J&J Medical). Follow up included 72h Holter ECG 3 and 12 months after ablation.

Results

In HFrEF group and nEF group 56 and 178 patients were included. HFrEF group was characterized by lower rate of women (21 vs. 49%, p 0.001), lower GFR (58±17 vs. 66±19, p 0.004), higher LAD (48±7 vs. 45±7, p 0.011), and higher CHA₂DS₂VASc-Score (3.8±1.4 vs. 3.1±1.5, p ). Age, BMI and diabetes prevalence were similar. Low voltage zones (LVZs) were found in 43% versus 36% (n.s.) in patients with HFrEF and nEF, respectively. A subanalysis of LA CARTO3D voltage maps was performed in patients ablated in 2016 and 2017, 106 patients (33 from HFrEF and 73 of nEF group). HFrEF patients showed LVZs in 64%, nEF patients in 51%, in patients with LVZs mean LVZ area % was 12±11% and 17 ±13, n.s. Rate of complications was 2% in HFrEF and 5% in nEF group. In 86% of patients complete follow up date are available.

12-months success rate off drugs was comparable (HFrEF 80% versus nEF 69%). In the HFrEF group patients without LVZs had excellent 12-months success rate off drugs (91%), patients with any LVZ had 67% success.

Conclusion

Data from our AF ablation registry show that patients with HFrEF and persistent AF may have excellent longterm success, in spite of larger LA. In some of the patients, tachymyopathy might have been the dominant pathogenetic factor for HFrEF. Further research is necessary to clarify if all AF patients with HFrEF gain benefit from an ablation.