CE-452776-3 IS RATE CONTROL EVER ADEQUATE? CATHER ABLATION IN RATE CONTROLLED ATRIAL FIBRILLATION WITH REDUCED EJECTION FRACTION

Abstract

The optimal rate control target for atrial fibrillation (AF) in the setting of heart failure with reduced ejection fraction (HFrEF) is not defined. Prior clinical trials have demonstrated benefits of AF ablation for patients with HFrEF, including recovery in left ventricular ejection fraction (LVEF). However, it is unknown if degree of rate control prior to ablation affects outcomes. To evaluate whether degree of pre-ablation rate control impacts LVEF recovery following AF ablation in patients with HFrEF. A single center, retrospective cohort study of 75 consecutive patients with LVEF ≤35% who underwent first-time ablation for persistent AF at NYU Langone Health between January 2014 and January 2021. Patients were classified as having a LVEF recovery if their post-ablation LVEF was >35%. Proportion of patients with LVEF recovery were compared between multiple rate control cutoffs: 110 bpm, 90 bpm, and 70 bpm. A binomial logistic regression analysis was then performed examining the relationship of pre-ablation HR on LVEF recovery. The mean pre-ablation HR was 90±25 bpm, baseline LVEF was 27±6%, and 64% (48/75) of patients had at least 3 months of maximal GDMT prior to ablation (Table 1A). Significant improvement in LVEF was observed in all patient subgroups irrespective of rate control status (Figure 1A) and regardless of prior GDMT (Figure 1B). Overall, LVEF recovery to >35% occurred in 59% (44/75) of patients. Compared to patients with pre-ablation HR faster than evaluated rate control cutoffs (Table 1B), there were no differences in frequency of LVEF recovery when using ≤110 bpm (controlled: 58% vs. not controlled: 63%, p=0.73) or ≤90 bpm (controlled: 52% vs. not controlled: 66%, p=0.21). In contrast, patients achieving rate control ≤70 bpm were significantly less likely to have LVEF recovery (41%) compared to those with HR above the cutoff (66%; p=0.04). Binomial logistic regression analysis did not reveal HR as a significant predictor of LVEF recovery (OR=1.01; CI 95%=0.99-1.03; p=0.16). Catheter ablation of persistent in AF in patients with HFrEF frequently resulted in improvement in LVEF, irrespective of achieved rate control. LVEF recovery >35% following catheter ablation was reduced only with rate control of HR 70bpm. Catheter ablation should be considered in HFrEF patients regardless of degree of rate control achieved. Heart rate 70bpm should be evaluated as a goal for adequate rate control in patients with HFrEF in whom rhythm control is not pursued.