Long-Term Outcome Of Pulmonary Vein Isolation Versus Amiodarone Therapy

...In Patients With Coexistent Persistent AF And Congestive Heart Failure

Cardiac Failure Review 2020;6:e04.


Abstract

Although pharmacological rhythm control of AF in patients with heart failure with reduced ejection fraction (HFrEF) does not seem to provide any benefit over rate control, catheter ablation of AF has been shown to improve clinical outcomes. These results can be explained with higher success rates of catheter ablation in restoring and maintaining sinus rhythm compared with antiarrhythmic drugs. In addition, pharmacotherapy is not void of side-effects, which are thought to offset its potential antiarrhythmic benefits. Therefore, efforts should be made towards optimisation of ablation techniques for AF in patients with HFrEF.


Conclusion

Catheter ablation of AF is more effective in restoring and maintaining sinus rhythm than pharmacological rhythm control with amiodarone. Most importantly, growing evidence suggests that catheter ablation is associated with a significant reduction in HF rehospitalisation and mortality likely because of a more stable, long-term maintenance of sinus rhythm and avoidance of side-effects of antiarrhythmic medications. Further large randomised clinical trials are warranted to confirm these results and to establish appropriate ablation strategies to maximise arrhythmia-free survival in HFrEF patients.


Michela Faggioni

Domenico G Della Rocca

Sanghamitra Mohanty

Chintan Trivedi

Ugur Canpolat

Carola Gianni

Amin Al-Ahmad

Rodney Horton

Gerald Joseph Gallinghouse

John David Burkhardt

Andrea Natale


Read the full article here: https://www.cfrjournal.com/articles/Pulmonary-Vein-Isolation-Amiodarone-Therapy-AF-Congestive-Heart-Failure

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