When atrial fibrillation is associated with heart failure and an ejection fraction <35%, what strategy should be considered?
Although a significant percentage of patients with AF have impaired EF, the vast majority of ablation procedures, in particular PVI, have been performed in patients with preserved LV systolic function, the combination of AF and structural heart disease being perceived to represent a different substrate involving a potentially higher risk of procedural complications. Patients with AF associated with heart failure have different symptoms from those presenting AF alone, suffering more from fatigue, dyspnoea, and low energy levels than from palpitations. Restoration of sinus rhythm by catheter ablation may present particular advantages for these patients by achieving not only symptom improvement, but also an enhanced EF and beneficial cardiac remodelling. In a study comparing the benefits and risks of PVI in patients with normal and impaired LV function, the percentage of patients free of AF in the absence of AAD following PVI (including a second ablation procedure if necessary) was not si
