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Background: Patients with both atrial fibrillation (AF) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF<55%) have a significantly higher risk of stroke and mortality. Improvement of LVEF has been reported in patients with AF and HF after endocardial ablation, but endocardial ablation in patients with persistent (PersAF) and longstanding persistent AF (LSPAF) has had low success in long-term freedom from atrial arrhythmias without repeat procedures. In this population, we sought to determine if a hybrid approach combining endocardial catheter ablation and epicardial surgical ablation would improve LVEF. Objective: To determine the effect of Hybrid Convergent ablation on LVEF in patients with AF. Methods: A multicenter, retrospective analysis of LVEF pre- and post- Hybrid Convergent was performed in consecutive patients with AF. LVEF was measured through 2D echocardiography. Mean baseline and post-procedure LVEF were compared by one sample t-test or Wilcoxon signed rank test. Results: Data from 158 patients, of whom 98% had PersAF/LSPAF, were included. At baseline, patients were a mean 65.7 ± 8.6 years of age, 74% male, BMI of 33 ± 5.7 kg/m2, and had a mean 6.4 ± 6.5 years history of continuous AF and approximately 27% had failed previous endocardial ablation. Patients with reduced baseline LVEF (<55%) experienced a significant improvement in LVEF versus baseline (+6.84% improved; p < 0.0001) at a mean follow up of 7.8 ± 8.7 months. The observed improvement was greatest in patients with severely reduced LVEF (<40% at baseline, +10.9% improved with mean follow-up of 9.3 ± 10.9 months, p = 0.0002). No change in LVEF was observed in patients with a normal baseline LVEF (p = 0.776). Conclusion: A significant improvement in LVEF was observed in patients with non-paroxysmal AF and reduced EF at baseline, particularly in those with severely reduced LVEF, after Hybrid Convergent ablation. [ABSTRACT FROM AUTHOR]

Introduction: The prospective, nonrandomized, multicenter Q‐FFICIENCY study demonstrated the safety and 12‐month efficacy of paroxysmal atrial fibrillation (AF) ablation with the novel QDOT MICRO temperature‐controlled, contact force‐sensing, radiofrequency (RF) catheter. Participants underwent pulmonary vein isolation with very high‐power short‐duration (vHPSD) mode (90 W, ≤4 s) alone or combined with conventional‐power temperature‐controlled (CPTC) mode (25–50 W). This study aimed to assess quality‐of‐life (QOL) and healthcare utilization (HCU) benefits experienced by Q‐FFICIENCY study participants. Methods: Besides evaluating procedural efficiency, QOL and HCU were assessed through 12 months postablation via Atrial Fibrillation Effect on Quality‐of‐Life Tool (AFEQT) score, antiarrhythmic drug (AAD) use, and incidence of cardioversion and cardiovascular hospitalization. Results: Of 191 participants enrolled, 166 were ablated with the new catheter. Compared to baseline, statistically significant, clinically meaningful improvements in composite and subcategories of AFEQT scores were observed at 3 months and sustained through 12 months (12‐month increase, 29.3–44.2 points). Class I/III AAD use decreased from 97.6% (162/166) at baseline to 19.6% (31/158) during Months 6–12, representing a significant 79.9% reduction. The cardioversion rate significantly declined by 93.9% from 31.3% (12 months preablation) to 1.9% (evaluation period). One‐year Kaplan–Meier estimates of freedom from all‐cause and cardiovascular hospitalization were 80.9% (95% confidence interval [CI], 74.8%–86.9%) and 88.8% (95% CI, 84.0%–93.7%), respectively. Conclusions: Paroxysmal AF ablation with the novel temperature‐controlled RF catheter in vHPSD mode, alone or with CPTC mode, led to clinically meaningful improvement in QOL and significant reduction in AAD use, cardioversion, and cardiovascular hospitalization. [ABSTRACT FROM AUTHOR]

Background: Q-FFICIENCY evaluated the safety and 12-month efficacy of temperature-controlled paroxysmal atrial fibrillation (AF) ablation with the QDOT MICRO Catheter. This subanalysis assessed efficiency, safety, efficacy, healthcare utilization, and quality of life (QOL) for participants ablated under near-zero fluoroscopy (=1 minute) compared with those ablated under higher fluoroscopy (>1 minute). Methods: In this nonrandomized, multicenter, US FDA-regulated study, participants underwent pulmonary vein isolation primarily with a very high-power short-duration (vHPSD; 90 W/=4 s) mode in combination with a conventional-power temperature-controlled (CPTC; 25-50 W) mode. The primary safety endpoint was incidence of primary adverse events =7 days postprocedure, while the primary effectiveness endpoint was freedom from documented atrial tachyarrhythmia recurrence and predefined failure modes (acute failure, repeat ablation, new/higher dose antiarrhythmic drug). Additional outcomes included clinical success (ie, freedom from documented symptomatic recurrence), cardiovascular hospitalizations, and QOL assessment per the Atrial Fibrillation Effect on Quality of Life Tool. Results: Of 165 participants with fluoroscopy data available, 44 received =1 minute of fluoroscopy exposure. The =1-minute of fluoroscopy group showed improved efficiency across all procedural parameters compared to the >1-minute of fluoroscopy group. Primary adverse event rates were similar for the =1-minute (4.5%) and >1-minute (3.3%) groups. The Kaplan-Meier estimated clinical success rate was likewise comparable for the =1-minute (85.4%) and >1-minute (86.0%) groups, as was freedom from cardiovascular hospitalization over 12 months (90.8% and 88.0%, respectively). Participants experienced similar improvement in QOL regardless of fluoroscopy exposure (=1-minute, +31.8 points; >1-minute, +31.5 points). Conclusion: Near-zero fluoroscopy ablation in paroxysmal AF with the novel temperature-controlled catheter in vHPSD mode, alone or combined with CPTC, was associated with improved procedural efficiencies and similar safety, efficacy, and clinical outcomes compared with cases performed with higher fluoroscopy exposure. [ABSTRACT FROM AUTHOR]

Background: Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking., Methods: We conducted an international randomized trial involving 1600 patients with atrial fibrillation who had an elevated score (≥2 in men and ≥3 in women) on the CHA 2 DS 2 -VASc scale (range, 0 to 9, with higher scores indicating a greater risk of stroke) and who underwent catheter ablation. Patients were randomly assigned in a 1:1 ratio to undergo left atrial appendage closure or receive oral anticoagulation. The primary safety end point, tested for superiority, was non-procedure-related major bleeding or clinically relevant nonmajor bleeding. The primary efficacy end point, tested for noninferiority, was a composite of death from any cause, stroke, or systemic embolism at 36 months. The secondary end point, tested for noninferiority, was major bleeding, including procedure-related bleeding, through 36 months., Results: A total of 803 patients were assigned to undergo left atrial appendage closure, and 797 to receive anticoagulant therapy. The mean (±SD) age of the patients was 69.6±7.7 years, 34.1% of the patients were women, and the mean CHA 2 DS 2 -VASc score was 3.5±1.3. At 36 months, a primary safety end-point event had occurred in 65 patients (8.5%) in the left atrial appendage closure group (device group) and in 137 patients (18.1%) in the anticoagulation group (P<0.001 for superiority); a primary efficacy end-point event had occurred in 41 patients (5.3%) and 44 patients (5.8%), respectively (P<0.001 for noninferiority); and a secondary end-point event had occurred in 3.9% and 5.0% (P<0.001 for noninferiority). Complications related to the appendage closure device or procedure occurred in 23 patients., Conclusions: Among patients who underwent catheter-based atrial fibrillation ablation, left atrial appendage closure was associated with a lower risk of non-procedure-related major or clinically relevant nonmajor bleeding than oral anticoagulation and was noninferior to oral anticoagulation with respect to a composite of death from any cause, stroke, or systemic embolism at 36 months. (Funded by Boston Scientific; OPTION ClinicalTrials.gov number, NCT03795298.)., (Copyright © 2024 Massachusetts Medical Society.)