Impact Of Atrial Fibrillation Ablation Research Articles

Impact of atrial fibrillation ablation in heart failure with reduced ejection fraction

Abstract Introduction Atrial fibrillation (AF) is the most common supraventricular arrhythmia in patients with heart failure (HF) and is associated with a significant increase in morbidity and mortality. Some studies have shown evidence in favor of ablation over pharmacological treatment in patients with AF and reduced ejection fraction (HFrEF). However, little is known about the generalizability of the trial results to routine clinical practice, particularly in a low- and middle-income country. Objective To evaluate whether catheter ablation (CA) of AF reduces morbidity and mortality compared to medical therapy alone in patients with HFrEF and AF in a real-word contemporary cohort from Argentina. Methods We consecutively identified patients with HF with ejection fraction less than 40% associated with paroxysmal or persistent AF who presented to our hospital, either as outpatients or inpatients, between February 2018 and June 2020. Baseline characteristics and outcomes were compared among patients undergoing CA or medical therapy alone. The primary outcome was all-cause mortality and first HF hospitalization until completing a 3-year follow-up. Propensity score overlap weighting was used to balance ablated and drug-treated patients on sex, age, body mass index, hypertension, diabetes, dyslipidemia, smoking, previous atrial fibrillation ablation, use of antiarrhythmic drugs, cardiac resynchronization, cardiac defibrillator, left ventricular ejection fraction, cardiovascular surgery, infarction, stroke, peripheral vascular disease, etiology of heart failure, respiratory disease and renal disease baseline characteristics. Results Data from 6297 patients with AF were analyzed, of whom 430 had ejection fraction ≤ 40%. We excluded 20 patients who were ablated for atrial flutter. 53 patients in the ablation and 357 patients in the medical therapy group were identified. After PS matching, the primary outcome occurred in 9 patients (23,7%) in the ablation group and in 19 patients (50%) in the control group. Catheter ablation was associated with a statistically significant reduction of the primary outcome in a 3-year follow up (Hazard ratio [HR] 0.33 [95%CI, 0.12-0.93]). Conclusion Catheter ablation for atrial fibrillation in patients with HFrEF was associated with decreased risk of mortality and heart failure hospitalisations relative to medical therapy.Kaplan-Meier survival estimates

Atrial fibrillation ablation in patients with reduced left ventricular ejection fraction: does it only improve hemodynamics or does it affect the prognosis? (A systematic review)

Objective: To critically evaluate the results of studies concerning the impact of atrial fibrillation ablation on hemodynamics and prognosis in patients with heart failure with reduced left ventricular ejection fraction.Methods: We searched via keywords in the PubMed, Embase, Cochrane Library, and Web of Science databases and selected the most-cited studies containing data on the ablation treatment of patients with atrial fibrillation and heart failure with reduced left ventricular ejection fraction, including such treatment end points as left ventricular ejection fraction, mortality, etc. We analyzed the effect of ablation on changes in left ventricular ejection fraction and clinical outcomes in patients with atrial fibrillation compared with that of drug therapy.Results: We screened 4581 literature sources: of them, 48 were selected for the review. Compared with drug therapy in similar patients with atrial fibrillation and heart failure, there is a 4-fold absolute increase (P < .001) in left ventricular ejection fraction after endocardial catheter ablation, thoracoscopic or hybrid ablation of atrial fibrillation. Some studies show a relative risk reduction in mortality (max 47%; P = .01) following the ablation in patients with atrial fibrillation and baseline reduced left ventricular ejection fraction.Conclusion: After atrial fibrillation ablation (regardless of the technique used and left ventricular dysfunction severity), patients with heart failure with reduced left ventricular ejection fraction show a statistically significant improvement in systolic function probably due to a decreased arrhythmia burden. Further research could determine the population of heart failure patients who would benefit most from atrial fibrillation ablation. Received 20 April 2023. Revised 6 June 2023. Accepted 7 June 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Impact of atrial fibrillation ablation on right ventricular failure and manifestation of heart failure with preserved ejection fraction symptoms: A case report

Catheter ablation is an important treatment modality for management of Atrial Fibrillation (AF). AF is a responsible factor in the pathophysiology of Heart Failure with Preserved Ejection Fraction (HFpEF). However, the relationship between AF and Right Ventricular (RV) dysfunction has not been completely distinguished.

Impact of atrial fibrillation ablation on activity minutes in patients with cardiac implantable electronic devices.

Impaired quality of life due to atrial fibrillation (AF), which often includes decreased activity level, is an indication for ablation. However, the impact of ablation for AF on activity is poorly understood. The purpose of this study was to assess the impact of ablation on activity minutes per day using continuous accelerometer data from cardiac implantable electronic devices (CIEDs). Using the Optum® Health Record dataset (2007-2019) linked with the Medtronic CareLink® database, we identified patients who had a CIED with AF detection and accelerometer capabilities. Patients with a device that transmitted heart rhythm and activity data ≥3 months before and ≥12 months after ablation were included in analysis. The associations between ablation and activity minutes were assessed for each CIED type. Of 4297 eligible patients who underwent AF ablation, 409 (9.5%) (65% male; age 67.3 ± 9.8 years; 64% paroxysmal AF) were included in analysis. The average AF burden and activity minutes per day preablation were 30.9% ± 37.4% and 175 ± 99 minutes, respectively. After ablation, relative AF burden decreased by 75.1% ± 53.2% (P <.001). There was no change in activity minutes per day after ablation in the entire cohort (average change -0.10 ± 36.2 minutes; P = .96). There were also no clinically significant changes in activity minutes postablation in subgroups based on CIED, season of ablation, quartile of AF burden change, and quartile of age at the time of ablation. There were no clinically significant changes in activity minutes per day in patients with CIEDs after ablation for AF.

Impact of atrial fibrillation ablation on long-term outcomes in patients with tachycardia-bradycardia syndrome.

BackgroundReports of long‐term outcomes after atrial fibrillation (AF) ablation for tachycardia‐bradycardia syndrome (TBS) are limited. This study aimed to investigate the impact of radiofrequency catheter ablation (RFCA) on clinical outcomes in patients with TBS.MethodsAmong 1669 patients who underwent AF ablation between January 2010 and April 2020, we retrospectively enrolled 53 patients (62.3% males; age, 67.1 ± 7.0 years) who had been diagnosed with TBS before RFCA for paroxysmal AF (TBS group). After 1:2 propensity score‐matching based on age, gender, AF type, and left atrial dimension, 106 patients were assigned to the control group (non‐TBS group). The atrial tachyarrhythmia (ATA) recurrence rate and rate of avoidance of permanent pacemaker implantation (PMI) were examined.ResultsDuring a median follow‐up period of 37.7 months, the ATA recurrence rate after a single ablation procedure was significantly higher in the TBS group than in the non‐TBS group (51.0% vs. 38.5%; log‐rank p = .008); however, the ATA recurrence rate after the final ablation procedure did not significantly differ between groups. In the TBS group, the rate of PMI avoidance after AF ablation was 92.5%. A Cox‐regression multivariate analysis revealed that the presence of non‐pulmonary vein/superior vena cava premature atrial contractions (odds ratio, 3.38; 95% confidence interval, 1.49–7.66; p = .004) was an independent predictor of ATA recurrence in the TBS group.ConclusionsPatients with TBS had higher ATA recurrence rates after the first ablation procedure compared to those without TBS. However, ATA recurrence after AF ablation did not necessarily result in PMI for TBS patients.

Abstract 13888: Impact of Atrial Fibrillation Ablation on Recurrent Cardiovascular Hospitalizations

Introduction: Atrial fibrillation (AF) ablation has been shown to improve quality of life in AF patients, however, its impact on healthcare resource utilization is not well established. We sought to evaluate the impact of AF ablation on cardiovascular hospitalizations as a surrogate for resource utilization. Methods: We retrospectively included consecutive patients undergoing AF ablation at our multi-hospital healthcare system (2013 - 2020). Hospital admissions were assessed in the 12-month period preceding the ablation procedure (or from the time of AF diagnosis, if AF was diagnosed &lt;12 months before ablation), and up to 24 months post-ablation. In each patient, pre- and post-ablation hospitalization rates were compared using paired t-test. Results: We included 4,310 patients who underwent AF ablation in our hospital system. Mean age was 63 ± 10 years, 65.5% were males, and mean CHA2DS2-VASc was 2.1 ± 1.5. AF ablation was associated with a statistically significant reduction in the total number of hospitalizations (0.7 ± 1.9 admission per person-year pre-ablation vs. 0.3 ± 0.7 post-ablation, P&lt;0.001), total number of cardiovascular hospitalizations (0.7 ± 1.2 admission per person-year pre-ablation vs. 0.2 ± 0.6 post-ablation, P&lt;0.001), total number of AF-related hospitalizations (0.6 ± 1.1 admission per person-year pre-ablation vs. 0.1 ± 0.4 post-ablation, P&lt;0.001), and total number of hospital admission days (2.2 ± 4.8 days per person-year pre-ablation vs. 1.3 ± 4.9 post-ablation, P&lt;0.001). The percentage of patients who had a cardiovascular hospitalization during each quarter (3-month period) of the pre- and post-ablation study period are shown in the Figure. Conclusions: In a large multi-hospital US healthcare system, AF ablation was associated with a significant reduction in the rates of hospitalization, including total, cardiovascular and AF-related hospitalizations, which may have significant implications for healthcare resource utilization.

Abstract 13250: Factors Associated With Improvement of Left Ventricular Function After Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure

Introduction: Catheter ablation is a well-established therapy for atrial fibrillation (AF), and studies have shown positive outcomes in patients with heart failure (HF). We aimed to evaluate the impact of AF ablation on echocardiographic and clinical parameters in patients with HF in Brazil, and to assess factors associated with improvement of the left ventricular ejection fraction (LVEF). Methods: Consecutive patients diagnosed with HF and LVEF &lt;50%, who underwent successful radiofrequency AF ablation in 5 high-volume institutions, were prospectively included. All patients underwent standard transthoracic echocardiography before the procedure and during clinical follow-up, and the analysis by the examiner was considered. The primary outcome was LVEF normalization (LVEF ≥50%) at follow-up. Clinical, echocardiographic, and procedure-related variables associated with the primary outcome were assessed by univariate logistic regression. P-value &lt;0.05 was considered significant. Results: From 2018 to 2020, 44 patients were included, being 28 (64%) males, mean age 66±11 years. Of these, 12 were in NYHA functional class 3/4, 35 had persistent AF, and only 3 had previous ablations. Mean pre-procedural LVEF was 38±7%, with 13 (30%) having LVEF&lt;35%. Complications occurred in only 2 patients, with 1 case of arterial pseudoaneurysm. In the 8.0±7.6 month follow-up, there was a substantial improvement of the LVEF to 53±14% (p&lt;0.001), and 27 (61%) achieved the primary outcome of LVEF normalization. Thirty patients (68%) had LVEF improvement of ≥10%, only 5 remained in NYHA class 3/4, and recurrent AF occurred in 11 (25%). Predictors of LVEF normalization were: pre-ablation LVEF (OR: 1.32, 95%CI 1.13-1.54, p=0.001), baseline left atrial diameter (OR: 0.87, 95%CI 0.77-0.98, p=0.02), baseline NYHA functional class 1/2 (OR: 5.11, 95%CI 1.29-21.28, p=0.025) and the absence of indication of spironolactone (OR: 5.60, 95%CI 1.20-26.14). There were 3 deaths, and none of them had LVEF improvement in follow-up echo. Conclusion: AF ablation in patients with HF resulted in remarkable echocardiographic and functional improvement, with low complication rates. Less clinical severity and less morpho-functional impairment were associated with LVEF normalization.

The impact of Atrial Fibrillation Ablation on Echocardiographic parameters: Single Center Experience

The impact of Atrial Fibrillation Ablation on Echocardiographic parameters: Single Center Experience

Impact of Atrial Fibrillation Ablation onRecurrent Hospitalization: A Nationwide Cohort Study.

This study assessed the impact of atrial fibrillation (AF) ablation on hospitalization and antiarrhythmic drug use in the community setting. Despite the widespread increase in the use of catheter ablation to treat AF in the United States, the impact of ablation on arrhythmic, cardiovascular, and noncardiovascular hospitalizations remains unclear. The national prospectively acquired Truven Health MarketScan data set (January 1, 2008 to December 31, 2014) was used to identify patients who underwent first time AF ablation with uninterrupted enrollment for 24 months (12 months pre-ablation and 12 months post-ablation). Multivariate logistic regression was used to determine predictors of hospitalization. Of 5,238 patients who underwent AF ablation for the first time, 2,720 patients with uninterrupted enrollment were analyzed (age 60 ± 10 years; 29% were women, 79% had hypertension, and 23% had heart failure [HF]). AF ablation was associated with significantly reduced all-cause hospitalization from 1,669 hospitalizations in the year before ablation to 1,034 hospitalizations in the year after ablation, which was driven primarily by a 56% reduction in arrhythmic hospitalization. Nonarrhythmic cardiovascular hospitalizations also declined through a 43% drop off in HF hospitalizations. Noncardiovascular hospitalization rates did not significantly change. Age younger than 55 years (odds ratio [OR]: 1.43; p< 0.001), obstructive sleep apnea (OR: 1.38; p< 0.001), and HF (OR: 1.29; p= 0.024) were multivariate predictors for decreased arrhythmic hospitalization. Rates of antiarrhythmic drug use also significantly declined post-procedure by 37.5% (p<0.001). In this nationwide cohort, AF ablation was associated with significant decreases in arrhythmic and nonarrhythmic cardiovascular hospitalizations, which was driven by reductions in hospitalization for AF and HF.

Real-world outcomes, complications, and cost of catheter-based ablation for atrial fibrillation: an update.

Catheter-based ablation for atrial fibrillation is a useful and effective form of rhythm-control therapy for symptomatic patients. This article reviews the 'real-world' experience on the outcomes, complications, and costs of atrial fibrillation ablation. Currently, real-world outcomes of atrial fibrillation ablation are derived from retrospective analysis of administrative databases or prospective registries from selected centers and patients. The rate of atrial fibrillation recurrence was reported to be as high as 60% and the rate of repeat ablation ranged from ≈10 to 18% within 1 year after ablation. All-cause hospitalizations after atrial fibrillation ablation were frequent, at up to ≈30% within 1 year and with up to half of them related to atrial fibrillation recurrence or repeat procedures. Rates of periprocedural complications were relatively low (≈3%). Female sex was associated with higher risk of complications such as bleeding, vascular injury, and tamponade. Markov models examining the cost-effectiveness of ablation yielded favorable results when success rates of more than 70% were assumed with long time horizons (>5 years). The real-world outcomes of atrial fibrillation ablation are sobering. Confirmation of these findings with prospective, population-based, minimally biased studies is needed. There is a critical need to delineate the downstream economic impact of atrial fibrillation ablation on society to justify its continued delivery and growth.

Abstract 13966: Catheter Ablation for Atrial Fibrillation Reduces the Recurrence of Ischemic Stroke

Introduction: Cardioembolic stroke related to atrial fibrillation (AF) is associated with a high recurrence rate and high mortality and morbidity. Catheter ablation for AF is effective in reducing AF burden, while the impact of AF ablation on a recurrence of stroke remains to be elucidated. Methods: We performed a retrospective multicenter cohort study of patients who were diagnosed with AF. A total of 1792 patients with AF (age 67±10, male 67%, 47% paroxysmal AF) were analyzed. Six hundred thirty-three patients underwent AF ablation. Patients with a history of transient ischemic attack (TIA) or ischemic stroke (IS) were listed. The association between a recurrence of TIA/IS, and AF ablation was evaluated. Results: There were 282 patients with a history of TIA/IS (104 ablation, 178 no-ablation). Ablation group had more patients with heart failure than no-ablation group. Besides this, there were similar about CHADS2 score in both group. Fifty-six recurrences were observed. AF ablation was associated with a lower incidence of recurrences (Hazard ratio 0.30; 95% CI 0.11 - 0.85; p=0.02). Independent predictors of recurrences of TIA/IS were, not undergoing AF ablation, aging, and a presence of hypertension. Conclusion: Our results suggested that AF ablation could reduce the recurrence of TIA/IS.

CATHETER ABLATION FOR THE TREATMENT OF ATRIAL FIBRILLATION REDUCES HEALTH CARE RESOURCE UTILIZATION

Catheter ablation (CA) is superior to anti-arrhythmic therapy at reducing recurrences of atrial fibrillation (AF); however, there is limited data regarding whether this translates into a reduction in health care resource utilization. Our objective was to evaluate the impact of AF ablation on long-

Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure

Background/objectivesCatheter ablation of atrial fibrillation (AF) might influence the cardiac autonomic nervous system. To investigate the impact of catheter ablation on the sympathetic nervous function in AF patients with and without heart failure (HF) using cardiac iodine-123-metaiodobenzylguanidine (123I-mIBG) scintigraphy, and the association of this effect with AF recurrence. MethodsForty consecutive patients (median age, 65 (54–69) years; male, 29) with paroxysmal (n=22) and persistent (n=18) AF who were scheduled for ablation were enrolled. Twelve (30%) of these patients also exhibited either stable HF, defined as an ejection fraction <40%, or a history of symptomatic HF. 123I-mIBG scintigraphy was performed at baseline and 3months post-ablation. The heart-to-mediastinum ratio of 123I-mIBG uptake at 15min (H/M15min) and 240min (H/M240min), as well as the washout rate (WR) were measured. ResultsDuring an 11±4-month follow-up, AF recurrence was observed in 8 (20%) patients receiving no antiarrhythmic drugs. Patients with HF had a tendency toward a lower baseline H/M15min (1.91±0.06 vs. 2.05±0.04, p=0.07), significantly lower H/M240min (1.88±0.22 vs. 2.14±0.28, p=0.008), and higher WR (40.3±9.0 vs. 32.3±7.4, p=0.007). Post-ablation, WR decreased in patients with HF (40.2±8.5 to 29.0±8.9, p=0.02) but slightly increased in those without (32.0±7.4 to 34.6±10.3, p=0.04). WR post-ablation independently predicted AF recurrence (adjusted hazard ratio=1.14 for 1 percentage point increase in the WR, 95% coincidence interval=1.02–1.34, p=0.02). ConclusionsAF ablation restores sympathetic nervous system status via attenuation of excessive adrenergic tone in HF patients. Elevated sympathetic nervous tone 3months post-ablation was a reliable predictor of AF recurrence.

The Impact of Atrial Fibrillation Ablation on Quality of Life.

Quality of life (QoL) is a very important endpoint in trials reporting the efficacy of catheter ablation in patients with atrial fibrillation (AF). It has been shown that AF ablation significantly improves the QoL, but recent studies question the usefulness of the most used generic QoL instrument in AF patients. The complexity of the disease makes it mandatory to employ disease specific instruments in the assessment of QoL. This paper reviews the current knowledge of various QoL instruments, including the limitations and pitfalls, and the impact of AF ablation on the QoL.

Catheter ablation of atrial fibrillation

The impact of atrial fibrillation on the healthcare systems of Western countries is overwhelming, due to its independent association with death, systemic thromboembolism, impaired quality of life and hospitalizations. Catheter ablation is the only treatment thus far demonstrated capable of achieving cure in a substantial proportion of patients. Pulmonary vein antrum isolation (PVAI) is the cornerstone of current atrial fibrillation ablation techniques, with the greatest efficacy as a stand-alone procedure in patients with paroxysmal atrial fibrillation. Use of general anesthesia, open-irrigated ablation catheters and maintenance of periprocedural therapeutic warfarin has been demonstrated to increase the safety and effectiveness of PVAI. In patients with paroxysmal atrial fibrillation, the systematic addition of superior vena cava isolation increases the long-term freedom from atrial fibrillation recurrence. A more extensive ablation approach extending to the entire left atrial posterior wall and to complex fractionated electrograms (CFAEs) is warranted in nonparoxysmal atrial fibrillation patients, in whom nonpulmonary vein trigger sites are frequently identified. Up to one-third of these patients experiencing atrial fibrillation recurrence after ablation have evidence of triggers from the left atrial appendage. Isolation of this structure is the best treatment strategy to improve the long-term success rate. In recent years, in addition to the development of ablation techniques to increase the success rate, outcomes of atrial fibrillation treatment trials have been reconsidered. In particular, reduction of hospitalization, stroke and mortality, as well as economic factors, have all been considered relevant to evaluate the effectiveness of atrial fibrillation treatment. Large ongoing trials are specifically evaluating the impact of atrial fibrillation ablation on these outcomes. This article will summarize the state-of-the art techniques for atrial fibrillation ablation, and will discuss the contribution of ongoing studies to the future of atrial fibrillation ablation.

The Impact of Atrial Fibrillation Ablation on Left Atrial Function: Association with Baseline Left Atrial Function

The effect of atrial fibrillation (AF) ablation on left atrial (LA) function has not been sufficiently determined. We enrolled 115 consecutive patients with paroxysmal or persistent AF that underwent AF ablation. Multidetector computed tomography was performed in sinus rhythm before and 3 months after ablation to evaluate LA volume (LAV) and function. Estimates of maximum and minimum LAV were used to calculate LA emptying fraction (LAEF) ([maximum-minimum LAV]/maximum LAV × 100). AF ablation significantly decreased maximum LAV (59.0 ± 20.4 to 53.3 ± 16.7 cm(3) , P = 0.001), and maintained LAEF (44.5 ± 13.1% to 43.7 ± 10.9%, P = 0.49). The larger the baseline maximum LAV, the greater the decrease in LAV after ablation, and a smaller baseline LAEF was associated with a larger recovery of LAEF after ablation (regression coefficient =-0.45 and -0.56, respectively, P < 0.0001). Multivariable analyses revealed that an impaired baseline LAEF was an independent predictor of an improvement in LA function (an increase in LAEF of >10%; odds ratio [OR] = 0.88, P < 0.0001), while an older age and preserved baseline LAEF were independently associated with a deterioration of LA function (a decrease in LAEF of >10%; OR = 1.06, P = 0.03; and OR = 1.10, P = 0.0001). AF ablation appears to have a beneficial effect on LA function in patients with impaired LA function at baseline. However, it may reduce LA function in patients with an older age and preserved baseline LAEF.

Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication

In the setting of congestive heart failure (CHF), atrial fibrillation (AF) ablation can improve clinical status and the left ventricular ejection fraction (LVEF) value. However, the impact of AF ablation on the implantable cardioverter defibrillator (ICD) indication has never been specifically addressed. Study subject were six CHF (mean age 61.1 +/- 6.9 years, mean LVEF 25.8 +/- 7.3%) patients refractory to conventional medical treatment with long-lasting AF unresponsive to external cardioversion. Five patients had an idiopathic dilated cardiomyopathy (DCM) and one had an ischaemic cardiomyopathy (ICM). Their New York Heart Association (NYHA) class was III-IV. Two patients had renal insufficiency. No patient had left ventricular delay. All patients underwent AF ablation. LVEF and NYHA class were dramatically improved in the five DCM patients. New York Heart Association class, but not the LVEF, was improved in the ICM patient. A redo ablative procedure was undertaken in four of five DCM patients and in the ICM patient due to arrhythmia recurrence. Left ventricular ejection fraction and NYHA were improved again in the DCM patients (56 +/- 4.4%, I-II, respectively) and led to ICD indication preclusion. The LVEF remained low in the ICM patient (30%) and led to ICD insertion. Sinus rhythm has been stable during the 18.1 +/- 5.7 months follow-up period. Atrial fibrillation ablation in CHF patients can improve both the clinical status of patients and their LVEF, especially among those affected by DCM. The LVEF improvement has the potential to preclude the indication for a primary prevention ICD insertion.

Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging

Beneficial effects of atrial fibrillation (AF) ablation have been demonstrated in patients with congestive heart failure (CHF) and significantly impaired left ventricular ejection fraction (LVEF). However, the impact of pulmonary vein isolation (PVI) on cardiac function in patients with paroxysmal AF and impaired LVEF remains under discussion. This study aimed to evaluate the impact of PVI for paroxysmal AF on cardiac function in patients with impaired LVEF using cardiac magnetic resonance imaging (CMRI). A total number of 70 patients with paroxysmal AF and episodes < or = 24 h were scanned on a 1.5-T-CMRI before and 6 months after PVI during sinus rhythm. End-diastolic volume, end-systolic volume, and LVEF were determined by epicardial and endocardial measurements. Patients were categorized into two groups regarding cardiac function as assessed by CMRI: group 1 patients (n = 18) with an LVEF < 50% and patients with an LVEF > 50% (group 2, n = 52). Group 1 patients demonstrated a significant lower success rate than patients of group 2 after a follow-up of 152 +/- 40 days (50 vs. 73%, P < 0.05). Cardiac magnetic resonance imaging in group 1 patients demonstrated a significant improvement in cardiac function after AF ablation (41 +/- 6 vs. 51 +/- 12%, P = 0.004), whereas group 2 patients did not show significant differences (60 +/- 6 vs. 59 +/- 9%, P = 0.22) after a 6 months follow-up. Pulmonary vein isolation improves cardiac function in patients with paroxysmal AF and impaired LVEF. These data suggest that an impaired LV function can be partially attributed to AF with short-lasting paroxysms.