Abstract 17194: Maintenance of Sinus Rhythm Following AF Ablation May Preclude ICD Implant for Primary Prevention of Sudden Death: a Pilot Study

Abstract

Background: Atrial fibrillation (AF) ablation is safe and efficacious in pts with AF and impaired LV systolic function. Furthermore, maintenance of sinus rhythm (SR) following AF ablation in pts with CHF has favorable impact on LVEF, functional status and quality of life. Current guidelines recommend an implantable cardiac defibrillator (ICD) for primary prevention of sudden death in pts with LVEF ≤ 35% on optimal medical therapy. Hypothesis: This pilot study was designed to test the following hypothesis: “SR after AF ablation in pts with AF and LVEF ≤ 35% will improve LV function and preclude an ICD”. Methods: Forty-nine consecutive pts with AF and impaired LV function (including pts with LVEF ≤ 35%) and controlled ventricular rates underwent AF ablation (electrogram-guided pulmonary vein isolation + linear and CFAE ablation if needed) before considering an ICD implant. All pts were rate controlled and on optimal medical therapy for CHF prior to AF ablation. All pts had strict clinical and rhythm monitoring until repeat LV function assessment post ablation. Results: Twenty-three pts had LVEF ≤ 35% (Group 1) and 26 pts had LVEF 36-50% (Group 2). Similar to other studies, 18 of 26 (69%) pts in Group 2 had an improved LVEF and no hospitalization post AF ablation. Importantly, 16 pts (70%) in Group 1 had improvement in mean LVEF from 30% to 44% which precluded an ICD implant. Eight of these 16 pts (50%) normalized their EF. Recurrent AF post ablation and myocardial scar due to ischemic cardiomyopathy likely accounted for lack of LVEF improvement in some pts. These pts received an ICD implant if their LVEF remained ≤ 35%. The only significant complication was 1 TIA in 1 pt. Conclusions: Maintenance of SR following AF ablation in pts with impaired LV systolic function improves LVEF. This pilot study suggests AF ablation may be considered prior to an ICD implant, particularly in pts with NICM. This pilot study warrants a prospective, multi-center investigation.