Table 1. Clinical characteristics and outcome of catheter ablation in patients with reduced systolic function.
AAD = antiarrhythmic drug; Abl = ablation; AF = atrial fibrillation; CFAEs = complex fractionated atrial electrograms; CHD = coronary heart disease; Consec = consecutive; mos = months; CS = coronary sinus; CTI = cavotricuspid isthmus; EF = ejection fraction; LA = left atrium; NR = not reported; LVEF = left ventricular ejection fraction; No. = number; NS = not significant; NYHA = New York Heart Association; Observ = observational; PAF = paroxysmal atrial fibrillation; Post = posterior; Prosp = prospective; Pt = patient; PVI = pulmonary vein isolation; QOL = quality of life; RA = right atrium; RCT = randomized controlled trial; Retro = retrospective; WACA = wide area circumferential ablation; † = EF improved among patients with sustained sinus rhythm; * = quality of life among catheter ablation patients compared with control;
| Hsu et al. (2004) | Chen et al. (2004) | Tondo, et al. (2006) | Gentlesk et al. (2007) | Lutomsky et al. (2008) | Nademanee, et al. (2008) | Khan et al. (2008) | De Potter et al. (2010) | MacDonald et al. (2011) | Cha et al. (2011) | Jones et al. (2013) | Nedios et al. (2014) | Hunter et al. (2014) | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Location | France | USA | Italy | USA | Germany | USA | Multi-center | Spain | UK (2 centers) | USA | UK | Germany, Greece | UK |
| Study design | Consec case control | Retro case series | Case control | Retro observ | Prospective, nonrandom | Observ | RCT: RFA vs AV nodal abl + CRT (PABA-CHF) | Case-control | RCT (Abl vs rate control) | Prosp, cohort | RCT (Abl vs rate control) | Retro, case-control | RCT (Abl vs rate control) |
| No. Ablated | 58 | 94 | 40 | 67 | 18 | 674 | 41 | 36 | 22 | 111 | 26 | 69 | 26 |
| Pt profile | |||||||||||||
| - Age | 56 | 57 | 57 | 54 | 56 | 45 | 60 | 51 | 62.3 | 55 | 64 | 60 | 55 |
| - LVEF | 35% | 36% | 33% | 42% | 41% | NR | 27% | 41% | 36% | 35% | 22% | 31% | 32% |
| - NYHA Class | 2.3 (mean) | 3 (68%) | 2.8 | NR | NR | 2 or 3 | NR | 3 (91%) | NR | 2.4 | 2.4 | 2.6 | |
| -Etiology | CHD 21% | CHD 86% | CHD 25% | CHD 18% | CHD 17% | CHD 21% | CHD 73% | CHD 9% | CHD 50% | CHD 13% | CHD 38% | CHD 38% | CHD 23% |
| - AF duration | 80 mos | 72 mos | 36 mos | 72 mos | NR | 40 mos | 48 mos | 78 mos | 44 mos | 65 mos | 51 mos | NR | 24 mos continuous |
| - PAF, % | 9 | 43 | 25 | 47 | 100 | 0 | 49 | 42 | 0 | 31 | 0 | 33 | 0 |
| Abl strategy | PVI + roof + mitral isthmus | PVI | PVI, mitral isthmus (85%) + CTI (98%) | PVI | PVI | CFAE | PVI + (lines, CFAEs) | PVI + box isolation of post wall + mitral isthmus | PVI + roof + CFAE + CS ± CTI | PVI (WACA); roof line (59%); mitral isthmus line (68%); Non-PV foci (25%) | PVI + roof and mitral lines; CFAE; CTI line | PVI (roof, mitral and “box” isolation of post wall in 64%) | PVI (WACA); CFAE (RA + LA); roof and mitral lines; CTI line |
| Repeat Abl | 50% | 22% | 13% | 31% | NR | 48% | 20% | 30% | 30% | 20% | 27% | 28% | 54% |
| Adverse events | 4% | 4% | 13% | NR | NR | 4.7% | 12% | 2.7% | 14.8% | 3.6% | 7.7% | 1.4% | 4.7% |
| Follow-up | 12 mos | 14 mos | 14 mos | 20 mos | 6 mos | 28 mos | 6 mos | 14 mos | 6 mos | 12 mos | 12 mos | 28 mos | 12 mos |
| Abl success(≥ 1 Abl ± AAD) | 69% (78%) | 73% (96%) | 50% (87%) | 63% (86%) | 50% | (81%) | 71% (88%) | 53% (69%) | 40% (50%) | 62% (76%) | 69% (88%) | 44% (65%) | 38% (73%) |
| EF improved | + 21% | + 5% (NS) | + 14% | + 14% | +10% | NR | + 8% | + 8% | + 8% | + 21% | + 11% | + 15%† | + 8% |
| 6 minute walk | Better with Abl | NR | NR | NR | NR | NR | Better with Abl | NR | Not improved with Abl | NR | Better with Abl | NR | NR |
| QOL* | Better with Abl | Better with Abl | Better with Abl | NR | NR | NR | Better with Abl | NR | Not improved with Abl | Better with Abl | Better with Abl | NR | Better with Abl |