Changes in ejection fraction after an ablate and pace procedure in patients with atrial fibrillation

Backround: “Ablate-and-pace” is an established procedure for selected patients with drug-refractory atrial fibrillation (AF). As consecutive right-ventricular pacing might have deleterious effects on left ventricular ejection fraction (LVEF), cardiac resynchronisation therapy (CRT) has been proposed as an alternative. Our aim was to evaluate the long-term follow-up of LVEF of such patients, to determine the rate of severe decline of LVEF and to find predictors. Methods: We included 27 patients with follow-up of >12 months and sufficient echocardiographic data for 65 ± 32 months. Last echocardiographic follow-up was performed after 61 ± 30 months. Main focuses were a decrease of LVEF to <35% and a decrease by >10%. Results: Mean LVEF at implant was 53% ± 9%. A LVEF of ≤40% (30%, 35% and 38%) was seen in three patients. At last follow-up, mean LVEF was 52% ± 8%. The three patients with a LVEF initially ≤40% improved (30% to 72%; 35% to 40%; 38% to 40%). LVEF changes in the three patients who at last follow-up had a LVEF of ≤40% were: 38% to 40%; 55% to 40%; 52% to 38%. In five patients (18%), LVEF decreased by ≥10%, though never to below 38%. The only predictors for a decrease in LVEF of ≥10% were lack of beta-blocker or angiotensin converting-enzyme inhibitor therapy at implant (p-values 0.02 and 0.003). Upgrade to CRT was performed in the patient with a LVEF of 38%. Conclusions: During long-term follow-up after “ablate-and-pace”, most patients with preserved or mildly impaired LVEF at implant do not exhibit a relevant decline in LVEF necessitating CRT upgrade.