Outcomes after stepwise ablation for persistent atrial fibrillation in patients with heart failure

There is limited data regarding the outcomes after stepwise ablation for persistent atrial fibrillation (AF) in patients with heart failure (HF). Patients without structural heart disease undergoing stepwise ablation for persistent AF (continuous AF=1 year) were studied (n=108; age, 61±10 years) and 32 patients had a history of HF. The HF patients were further grouped on the basis of left ventricular ejection fraction (LVEF)=45% (n=15) and >45% (n=17). During a median follow-up period of 2.2 years, repeated ablations were necessary in 65 patients. The proportion of patients that were arrhythmia free 1 year after the last ablation was 67% in patients with LVEF=45%, 86% in LVEF>45%, and 91% in no HF (p=0.0009). In patients with LVEF=45%, the AF burden was reduced to less than one paroxysmal episode per month, and patients with and without recurrences both showed significant increases in LVEF over the follow-up period (38±7% to 60±10% and 37±6% to 53±10%, respectively). HF patients with LVEF=45% had lower chances to remain free from arrhythmias after stepwise ablation for persistent AF than those with LVEF>45%. Nevertheless, LVEF also improved in patients with recurrences, reflecting the observed reduction in AF burden and emphasizing the benefits of ablation.