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Intermountain Health Care
Jared Bunch

MURRAY — The presence of atrial fibrillation in patients with heart failure is a complication that dishes up serious adverse effects, including raising the risk of stroke and dementia, while reducing the likelihood of survival.

But a new study from Intermountain Medical Center proves that aggressively treating it with catheter ablation not only reduces those risks, but reverses damage as if the fibrillation had not occurred.

The researchers presented their results Friday in San Francisco at the Heart Rhythm Society's 32nd Annual Scientific Session.

The coexistence of the two heart conditions greatly complicates an already troubled health picture, "with much more rapid decline in heart function, worsening heart failure and premature mortality," said Dr. John D. Day, cardiologist and director of Intermountain Medical Center Heart Institute's Heart Rhythm specialists.

In heart failure, the heart muscle is weakened and does not pump adequately. Patients are tired, weak and out of breath, and treatment is typically a tightly controlled regimen of medication, food and therapy. Liquids, for instance, are severely restricted in advanced cases and daily weighing is an essential part of monitoring the disease to detect fluid retention.

Atrial fibrillation is an electrical problem that makes the heart's upper chamber muscle bounce erratically instead of beating,

The heart pumps inefficiently and blood can pool or clot, instead of going where it's supposed to, with increased risk of stroke. It's treated with a variety of tools, including medication, but the most aggressive treatment is electrical ablation, in which tissue is scarred with pulses of highly focused heat or radio frequency energy to change and correct the circuitry.

The study was based on an examination of 100 atrial fibrillation patients who also suffered moderate to severe left ventricular heart failure. By comparing what happened to a group of patients who had ablation to a control group of similar patients who did not have ablation, the researchers found that within three years of being ablated, it was very like they'd never had atrial fibrillation.

"We found in those with atrial fibrillation treated with ablation who had heart failure, compared to those who never had atrial fibrillation, if we did the ablation and they maintained a normal rhythm, the outcomes all became similar, said Dr. Jared Bunch, study principal investigator and director of heart rhythm research at the institute.

That's especially important because when medications have been used to do the same, no benefit has been proved. "This reflects that ablation can be done relatively safely, without long-term risk like medications do on a day-to-day basis when they're taken chronically."

Day noted that patients who have heart failure typically need more ablation than patients without the chronic condition when they have atrial fibrillation.

With heart failure, they're sicker, so "we also have to ablate a lot more tissue." And there are patients for whom ablation is not an option, either because they have such advanced heart failure that the risk is too great or because very long-term atrial fibrillation has made it unlikely ablation will be successful enough to justify the risks.

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