PO-455617-16 EFFECTS OF ADDING POSTERIOR WALL ISOLATION TO PULMONARY VEIN ISOLATION IN PERSISTENT ATRIAL FIBRILLATION AND HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF)

Catheter ablation in AF and heart failure with reduced ejection fraction (HFrEF) is associated improved left ventricular fraction(LVEF) survival compared medical therapy. Previous non-randomized studies have shown high success rates adjunctive strategies beyond pulmonary vein isolation (PVI), including posterior wall (PWI). To examine differences arrhythmia outcomes between PVI alone versus PWI patients concomitant persistent (PsAF) HFrEF CAPLA was a multi-centre, prospective, randomized trial involving PsAF assigned to or PWI. This substudy included HFrEF(LVEF<50% on echocardiography). The primary endpoint freedom from any documented atrial of>30 seconds, after single procedure, off anti-arrhythmic therapy(AAD) at 12 months. 98 HFrEF(mean age 62.1+/-9.8 years, 79.5% males, median LVEF 35+/-13%). 46.9% underwent After months, 58.7% were free recurrent AAD vs 61.5% of (HR1.02, 95% CI 0.54-1.91, p=0.96). There no significant on/off multiple procedures (PVI 60.9% 65.4%; HR1.12, 95%CI 0.58-2.16; p=0.73), symptomatic 69.5% 75%; HR 1.23, 0.58-2.62; p=0.59), burden months 0% [IQR 0-2.63] [IQR0-2.59]; p=0.78). Median PWI(LVEF increased by19.3+/-12.9%,p<0.01), (LVEF by 18.2+/-14%, p<0.01), difference groups(p=0.71). Normalisation LV function(≥50%) occurred 71.4% 59.1% alone(p=0.26). improvements HFrEF. However adding did not improve recurrence nor recovery LVEF.