Clinical impact of catheter ablation for atrial fibrillation on heart failure parameters

Abstract Background Catheter ablation for atrial fibrillation have already been an established therapy to maintain sinus rhythm in patients with or without heart failure. Atrial fibrillation is often associated with functional valve regurgitations, left ventricular dysfunction and biomarkers of HF. However, it is still unclear how often such parameters improve after catheter ablation. Purpose The aim of this study is to clarify the clinical impact of catheter ablation on heart failure in patients with atrial fibrillation. Methods We retrospectively analysed 139 consecutive patients who underwent catheter ablation for atrial fibrillation and cardiac echocardiography before and one-year after catheter ablation. Patients who underwent hemodialysis or previous valve surgery were excluded. Results Mean age was 69.8±9.5 years and 84(60.4%) patients had persistent atrial fibrillation before ablation procedure. Fourteen (10.1%) patients had severe left ventricular dysfunction (EF<40%). Thirty-four (24.5%) and 37(26.6%) patients had moderate or greater mitral and tricuspid valve regurgitation (MR and TR), respectively. BNP or NTproBNP was significantly elevated in 93(66.9%) patients before catheter ablation. During one-year follow-up, 11 (7.9%) patients underwent second procedure and atrial fibrillation were remained in 2 (1.4%) patients. Additional medications for heart failure were prescribed in 19 (13.7%) of patients after initial procedure. One year after catheter ablation, 19/34(55.9%) and 20/37(54.1%) of moderate or greater functional MR and TR improved to mild or less. Furthermore, 5/14 (35.7%) patients with severe left ventricular dysfunction improved to normal with combined optimal medical treatment. In 64/93 (68.8%) with elevated BNP or NTproBNP, the increase was no longer significant. Even in patients with still elevated BNP or NTproBNP one-year after catheter ablation, their values were decreased by more than 50% in 17/29 (58.6%) patients. Conclusion Catheter ablation for atrial fibrillation can improve heart failure parameters including valve function, systolic ventricular function and biomarkers.