Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-168 - Avoidance Of Defibrillator Implantation After Ablation Of Atrial Fibrillation In Systolic Heart Failure (ID 947)

 A. Shah: Nothing relevant to disclose.


Background: In randomized trials of patients with systolic heart failure, catheter ablation (CA) of AF is associated with improvement in left ventricular ejection fraction (LVEF). We sought to determine the frequency and outcomes of patients who avoided implantable cardioverter defibrillator (ICD) because of LVEF improvement following CA for AF.
Objective: To determine the frequency of avoidance of primary prevention ICD implantation in patients with systolic heart failure undergoing CA of AF
Methods: All patients with LVEF <35% on optimized heart failure therapy with New York Heart Failure class functional status 2 or greater who underwent CA for persistent AF at the Robert Packer Hospital between 2013 to 2019 were evaluated for change in LVEF after CA and implantation of ICD after CA
Results: Of 651 patients who underwent CA for AF, a total of 119 patients had LVEF <35% (mean 28.8 ± 6.7%), mean age 68.7 ± 7.9, 81% male, and 35% with ischemic cardiomyopathy. After a follow up of 2.8 ± 1.9 years these 35 (29%) had ICD preceding CA and 26 (22%) received an ICD after CA. A total of 58 (49%) had no ICD implanted in follow up with improvement from a baseline LVEF of 20.8 ± 6.5% to 47.2 ± 14.4% with 48 (83%) improving to greater than 35%. The entire cohort had a similar increase in LVEF to 43.7± 12.0% whereas patients with prior ICD had LVEF change from 26.4± 6.3% to 32.3± 16.8%. Of patients receiving an ICD following CA, 10 had improvement in LVEF>35 and had ICD placed at the time of cardiac resynchronization therapy, prior to LVEF improvement, or per the request of the primary cardiologist.
Conclusion: In patients with systolic heart failure, CA of AF may obviate the need for primary prevention ICD in a significant fraction of patients.