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Pulmonary venous isolation for atrial fibrillation in severe systolic heart failure: more questions than answers?
  1. Rodney H Falk
  1. Correspondence to Dr Rodney H Falk, Department of Cardiology, Harvard Vanguard Medical Associates, 133, Brookline Ave, Boston, MA 02215 USA; rfalk{at}partners.org

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In their paper published in this issue of Heart, MacDonald and coworkers report the results of a trial comparing radiofrequency ablation of atrial fibrillation (AF) with ventricular rate control in a group of patients with persistent AF and congestive heart failure (see page 740).1 They point out that such a trial has not been reported before and they conclude that, for the group, there was no difference in the primary end point—namely, change in left ventricular ejection fraction (LVEF) as measured by cardiac MRI.

A 50% failure to maintain sinus rhythm despite repeat ablation is greater than the rates usually reported in larger series. However, most published studies have limited the population reported to paroxysmal arrhythmia, or have combined patients with paroxysmal and persistent arrhythmia, and the majority of patients have had normal ventricular function.2 3 In a recent study comparing success rates of ablation in a group of patients with a reduced ejection fraction (EF) and AF with patients with a normal EF, the initial success rate was 50% in the low …

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