AB-452643-4 EFFECTS OF ADDING POSTERIOR WALL ISOLATION TO PULMONARY VEIN ISOLATION IN PERSISTENT ATRIAL FIBRILLATION AND HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF)

Abstract

Catheter ablation in AF and heart failure with reduced ejection fraction (HFrEF) is associated with improved left ventricular ejection fraction(LVEF) and survival compared with medical therapy. Previous non-randomized studies have shown high success rates with adjunctive ablation strategies beyond pulmonary vein isolation (PVI), including posterior wall isolation (PWI). To examine differences in arrhythmia outcomes between PVI alone versus PVI with PWI in patients with concomitant persistent AF (PsAF) and HFrEF CAPLA was a multi-centre, prospective, randomized trial involving PsAF patients assigned to PVI alone or PVI with PWI. This substudy included patients with HFrEF(LVEF<50% on echocardiography). The primary endpoint was freedom from any documented atrial arrhythmia of>30 seconds, after a single ablation procedure, off anti-arrhythmic therapy(AAD) at 12 months. 98 patients with PsAF and HFrEF(mean age 62.1+/-9.8 years, 79.5% males, median LVEF 35+/-13%). 46.9% underwent PVI with PWI. After 12 months, 58.7% with PVI and PWI were free from recurrent atrial arrhythmia off AAD vs 61.5% of patients with PVI alone (HR1.02, 95% CI 0.54-1.91, p=0.96). There were no significant differences in freedom from any atrial arrhythmia on/off AAD after multiple procedures (PVI with PWI 60.9% vs PVI 65.4%; HR1.12, 95%CI 0.58-2.16; p=0.73), freedom from symptomatic atrial arrhythmia on/off AAD after multiple procedures (PVI with PWI 69.5% vs PVI 75%; HR 1.23, 95%CI 0.58-2.62; p=0.59), or median AF burden at 12 months (PVI with PWI 0% [IQR 0-2.63] vs PVI 0% [IQR0-2.59]; p=0.78). Median LVEF improved in PVI with PWI(LVEF increased by19.3+/-12.9%,p<0.01), and PVI alone (LVEF increased by 18.2+/-14%, p<0.01), with no difference between groups(p=0.71). Normalisation of LV function(≥50%) occurred in 71.4% in PVI with PWI compared with 59.1% with PVI alone(p=0.26). Catheter ablation is associated with significant LVEF improvements in PsAF and HFrEF. However adding PWI to PVI did not improve freedom from arrhythmia recurrence nor recovery of LVEF.