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AF ablation reverses 'idiopathic' cardiomyopathy.

SAN FRANCISCO -- Many patients who have atrial fibrillation along with a low left ventricular ejection fraction in the absence of coronary disease appear to have an unrecognized atrial fibrillation-induced cardiomyopathy that's reversible upon catheter ablation of the atrial arrhythmia, Dr. Philip Gentlesk said at the annual meeting of the Heart Rhythm Society.

Traditionally, patients with a decreased ejection fraction and atrial fibrillation (AF) in the absence of ischemic heart disease were diagnosed with "idiopathic" dilated cardiomyopathy. But catheter ablation of AF is generating evidence that casts doubt on that traditional interpretation, according to Dr. Gentlesk of the University of Pennsylvania, Philadelphia.

He reported on 366 consecutive patients who underwent pulmonary vein isolation to ablate highly symptomatic drug-refractory AF. Of those, 293 had paroxysmal AF and the remainder had persistent AF. Of 67 patients who had a left ventricular ejection fraction of 50% or less, 12 had ischemic or valvular heart disease and 55 had idiopathic dilated cardiomyopathy. After a mean 1.4 catheter ablation procedures and 20 months of follow-up, the rate of AF control--defined as at least a 90% reduction in the burden of AF--was 87% and 86% in patients with normal and low baseline ejection fractions, respectively.

Some other investigators have questioned the efficacy of catheter ablation of AF in patients with a decreased ejection fraction. However, the Pennsylvania experience has been that the results are essentially the same as in those with a normal ejection fraction, he said.

The mean baseline ejection fraction in 50 patients diagnosed with idiopathic dilated cardiomyopathy was 44%. At follow-up 20 months later, their mean ejection fraction was 57%.

BY BRUCE JANCIN

Denver Bureau
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Title Annotation:Cardiovascular Medicine
Author:Jancin, Bruce
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Sep 15, 2004
Words:272
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