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Review
. 2023 Sep 5;82(10):1039-1050.
doi: 10.1016/j.jacc.2023.06.029.

Ablation to Reduce Atrial Fibrillation Burden and Improve Outcomes: JACC Review Topic of the Week

Hannah T Schwennesen  1 , Jason G Andrade  2 , Kathryn A Wood  3 , Jonathan P Piccini  4
Affiliations
Review

Ablation to Reduce Atrial Fibrillation Burden and Improve Outcomes: JACC Review Topic of the Week

Hannah T Schwennesen et al. J Am Coll Cardiol. .

Abstract

Atrial fibrillation is the most common atrial arrhythmia and accounts for a significant burden of cardiovascular disease globally. With advances in implanted and wearable cardiac monitoring technology, it is now possible to readily and accurately quantify an individual's time spent in atrial fibrillation. This review summarizes the relationship between atrial fibrillation burden and adverse cardiovascular and cerebrovascular outcomes and discusses the role of catheter ablation to mitigate the morbidity and mortality associated with greater burden of atrial fibrillation.

Keywords: catheter ablation; heart failure; mortality; stroke.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Andrade has received grants and personal fees from Medtronic; has received grants from Baylis; and has received personal fees from Biosense-Webster. Dr Wood has received honoraria for speaking/consulting from Milestone Pharmaceuticals. Dr Piccini is supported by R01AG074185 from the National Institutes of Aging; has received grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips; and has served as a consultant to Abbott, AbbVie, ARCA Biopharma, Bayer, Boston Scientific, Bristol Myers Squibb (Myokardia), Element Science, Itamar Medical, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips, and Up-to-Date. Dr Schwennesen has reported that she has no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1. Clinical classifications of AF versus classification by AF burden
Atrial fibrillation (AF) has historically been classified based on clinical presentation. Wearable and implantable cardiac monitoring devices allow for more granular classifications based on AF burden.
Figure 2
Figure 2. Effect of AF burden on stroke risk
Left: stroke risk with non-paroxysmal atrial fibrillation (AF) compared to paroxysmal AF. Right: stroke risk with greater AF burden at differing cutoffs.
Figure 3
Figure 3. Effect of AF burden on mortality and heart failure hospitalizations
Greater atrial fibrillation (AF) burden is associated with increased risk of mortality; greater AF burden and progression are associated with increased risk of hospitalization for heart failure. The magnitude of effect is greater in patients with LVEF ≥50%. a) Data from Taillandier et al. b) Data from Steinberg et al. c) Data from Wong et al. h = hours, HF = heart failure, LVEF = left ventricular ejection fraction
Figure 4
Figure 4. Effect of catheter ablation versus medical therapy on AF burden
Patients treated with catheter ablation have lower atrial fibrillation (AF) burden at follow-up compared to patients treated with pharmacologic therapy.
Central illustration
Central illustration. Cardiovascular outcomes of AF burden and the impact of ablation
Greater atrial fibrillation (AF) burden is associated with lower quality of life and greater risk of adverse cardiovascular outcomes. By reducing AF burden, catheter ablation of AF decreases many of the adverse effects associated with greater burden. HF = heart failure, QoL = quality of life
See this image and copyright information in PMC

References

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