PO-637-01 ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH SEVERELY REDUCED EJECTION FRACTION PRIOR TO CONSIDERATION OF PRIMARY PREVENTION ICD IMPLANTATION

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Recent clinical trials of atrial fibrillation (AF) ablation in patients with reduced left ventricular ejection fraction (LVEF) to ≤ 35% with implantable cardioverter defibrillators (ICDs) have shown significant improvement in LVEF and mortality following catheter ablation. There are little data examining outcomes of AF ablation in patients with LVEF ≤35% prior to ICD implantation. To compare AF ablation outcomes of patients with LVEF ≤ 35% with an implanted ICD to those without an ICD, stratified by etiology of cardiomyopathy (CM). A single center, retrospective cohort study of all consecutive patients with LVEF ≤ 35% who underwent first-time AF ablation at NYU Langone Health between January 1, 2014 and January 1, 2021. Clinical and echocardiographic outcomes comparing patients with an implanted ICD to those without an implanted ICD were analyzed within one year follow-up. This study consisted of 102 patients, including 57 without an ICD and 45 with an ICD. Baseline characteristics were similar between groups, with the exception a greater prevalence of diabetes among patients with an ICD (No ICD: 14% vs ICD: 31%; p=0.037). There was no difference in baseline LVEF between groups (No ICD: 28% ± 7% vs ICD: 27% ± 6%; p=0.586). Procedural outcomes for both groups, including arrhythmia-free survival, were similar at 1 year (Figure 1). Patients without an ICD had a greater mean improvement in LVEF compared to patients with an ICD (+17% ± 10% vs +5% ± 10%, respectively; p<0.001). Among patients without an ICD, 33 of 44 (75%) had LVEF >35% at follow-up, including 25 of 31 (81%) with nonischemic cardiomyopathy and 8 of 13 (62%) with ischemic cardiomyopathy. Most patients undergoing AF ablation with LVEF ≤ 35% without an implanted ICD experienced improvement in LVEF to >35%, regardless of cardiomyopathy etiology. Patients without an ICD had significantly greater improvement in LVEF compared to patients with an implanted ICD. The role of rhythm-control prior to primary prevention ICD implantation for patients with LVEF ≤ 35% requires further investigation.