Prognostic impact of diagnosis-to-ablation time on outcomes following catheter ablation in persistent atrial fibrillation and left ventricular systolic dysfunction.

Autor:	Segan L; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., Kistler PM; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia; Melbourne Private Hospital, Melbourne, Australia., Chieng D; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., Crowley R; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., William J; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., Cho K; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia., Sugumar H; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia; St Vincent's Hospital, Melbourne, Australia; Royal Australasian College of Physicians Foundation, Melbourne, Australia., Ling LH; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., Voskoboinik A; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia., Hawson J; University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia., Morton JB; University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia., Lee G; University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia., Sanders P; Royal Adelaide Hospital, Adelaide, Australia., Kalman JM; University of Melbourne, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia., Prabhu S; Baker Heart and Diabetes Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne Australia. Electronic address: S.Prabhu@alfred.org.au.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Sep 27. Date of Electronic Publication: 2024 Sep 27.
DOI:	10.1016/j.hrthm.2024.09.059
Abstrakt:	Background: The optimal timing of catheter ablation in individuals with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) remains uncertain. Objective: We examined whether AF diagnosis to ablation time (DAT) influences outcomes following catheter ablation (CA) in patients with persistent AF (PsAF) and LVSD from the CAMERA-MRI and CAPLA randomized studies. Methods: We evaluated clinical outcomes according to DAT < 1 year ("shorter DAT") and ≥1 year ("longer DAT"), comparing AF recurrence, AF burden, left ventricular ejection fraction (LVEF), and LV recovery (LVEF ≥ 50%) at 12 months. DAT was also compared according to the median (24 months). Results: Two hundred and ten individuals with AF and LVSD were identified, with a median DAT of 24 months. Shorter DAT was associated with lower LA global and posterior wall scar (<0.05 mV; both P < .05). At 12 months, 69.4% with shorter DAT (<1year) were free from recurrent atrial arrhythmias vs 53.6% in longer DAT (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.01-2.65, P = .040). Median AF burden was 0% in both groups (shorter DAT: interquartile range [IQR] 0.0-2.0% vs longer DAT: IQR 0.0-7.3%, P = .017). At 12 months, shorter DAT was associated with higher LVEF (55.3% vs 51.0%, P = .009), greater LVEF improvement (+20.8 ± 13.0% vs +13.9 ± 13.2% longer DAT, P < .001) and LV recovery (75.0% vs longer DAT: 57.2%, P = .011). Shorter DAT was associated with fewer hospitalizations and electrical cardioversions at 12 months. Conclusion: In individuals with AF and LVSD, shorter DAT was associated with greater LVEF improvement and arrhythmia-free survival with lower AF burden and rehospitalization at 12 months, highlighting the prognostic benefit of early CA in AF and LVSD. Competing Interests: Disclosures The following industry funding sources regarding activities outside the submitted work have been declared in accordance with ICMJE guidelines. Dr Segan is a recipient of a cofunded NHMRC and National Heart Foundation PhD stipend. Dr Kistler is a recipient of the Investigator grant from the NHMRC and has received funding from Abbott Medical for consultancy and speaking engagements and has served on the advisory board with fellowship support from Biosense Webster. Dr Kalman has received fellowship support from Medtronic and Biosense Webster. Dr Lee has received consulting fees from Biosense Webster. Dr Prabhu is supported by a NHMRC Post-Doctoral Research Fellowship and has received consulting fees, fellowship support, and educational grants from Biosense Webster, Abbott Medical, and Boston Scientific. The remaining authors have no conflicts of interest to disclose. (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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