Atrial fibrillation ablation versus medical therapy in arrhythmia-induced cardiomyopathy: a propensity score analysis.

Introduction: Arrhythmia-induced cardiomyopathy (AIC) due to atrial fibrillation is probably related to high ventricular rates and irregular rhythm caused by atrial fibrillation. We sought to investigate the efficacy of pulmonary vein isolation (PVI) using radiofrequency catheter ablation (RFCA) compared to conventional medical therapy in terms of rate of hospitalizations and atrial fibrillation recurrence.

Methods: All patients diagnosed with atrial fibrillation associated with heart failure and left ventricular ejection fraction (LVEF) less than 50%, with no other identifiable cause of heart failure aside from the tachyarrhythmia, were included. A 1 : 1 propensity score matching was carried out including age, sex, diabetes, LVEF and BMI in the logistic regression model. The primary endpoint was to assess recurrences of hospitalizations for heart failure; secondary endpoints included hospitalizations for all causes and recurrence of atrial fibrillation during the follow-up.

Results: Seventeen patients who had undergone RFCA were matched and compared with 17 patients under conventional medical therapy. Over a median follow-up of 26 months [interquartile range (IQR) 13.4-32], the RFCA group exhibited a significantly lower rate of heart failure-related hospitalization compared with the control group (23.5 versus 58.8%, P = 0.04). The rates of all-cause hospitalizations and atrial fibrillation recurrence were also significantly lower in the RFCA group. The RFCA group also showed a significant increase in LVEF and a significant reduction in left atrial volume compared with medical therapy alone.

Conclusion: In patients with AIC due to atrial fibrillation, catheter ablation seems to favor the reverse remodeling and to be effective in reducing atrial recurrence and the rate of all-cause and heart failure-related hospitalizations.