How would you treat Atrial Fibrillation with a Low Ejection Fraction?

Followings are the three methods performed by different school of thoughts:

1)Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function.
OBJECTIVES: We aimed to determine the safety and efficacy of pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients with impaired left ventricular (LV) systolic function.

BACKGROUND: To date, PVI has been performed primarily in patients with normal LV function. Yet, many AF patients have impaired LV systolic function. The outcomes of PVI in patients with impaired LV systolic function are unknown.

METHODS: We included 377 consecutive patients undergoing PVI between December 2000 and January 2003. Ninety-four patients had impaired LV function (ejection fraction [EF] <40%), and they comprised the study group. The control group was the remaining 283 patients who had a normal EF. End points included AF recurrence and changes in EF and quality of life (QoL).

RESULTS: Mean EF was 36% in our study group, compared with 54% in controls. After initial PVI, 73% of patients with impaired EF and 87% of patients with normal EF were free of AF recurrence at 14 卤 6 months (p = 0.03). In the study group, there was a nonsignificant increase in EF of 4.6% and significant improvement in QoL. Complication rates were low and included a 1% risk of pulmonary vein stenosis.

CONCLUSIONS: Although the AF recurrence rate after initial PVI in impaired EF patients was higher than in normal EF subjects, nearly three-fourths of patients with impaired EF remained AF-free. Although our sample size was nonrandomized, our results suggest PVI may be a feasible therapeutic option in AF patients with impaired EF. Randomized studies with more patients and longer follow-up are warranted.

2)Catheter Ablation of Atrial Fibrillation. A 74-year-old man with atrial fibrillation (AF) underwent electrophysiologic study and catheter ablation with a noncontact mapping system. AF was induced by coronary sinus pacing, and noncontact mapping showed ever-changing movement of multiple wavefronts with one dominant reentrant circuit around the tricuspid annulus, splitting wavefront conduction through the gaps in the crista terminalis, and then fusion and stasis of wavefronts. After creation of bidirectional conduction block over crista terminalis gaps and the cavotricuspid isthmus, AF or atrial flutter was noninducible. No further AF recurrence was noted during 6-month follow-up.

3)Irrigated-Tip Catheter Ablation of PVs. Introduction: Catheter ablation of pulmonary veins (PV) for treatment of atrial fibrillation (AF) is limited by the disparate requirements of sufficient energy delivery to achieve PV isolation while avoiding PV stenosis. The aim of the present study was to evaluate the safety and efficacy of using an irrigated-tip catheter for systematic isolation of PV.

Methods and Results: The study population consisted of 136 consecutive patients (109 men, mean age 52 卤 10 years) with symptomatic, drug-refractory paroxysmal (122) or persistent (14) AF. Cavotricuspid isthmus ablation and systematic radiofrequency isolation of all four PVs (guided by a circumferential mapping catheter) was performed in all patients with a protocol using an irrigated-tip catheter. PV diameter was assessed by selective angiography. The electrophysiologic endpoint of PV isolation was achieved in 100% of patients. Bidirectional cavotricuspid isthmus block was achieved in 99% of patients. Moderate PV stenosis (50% narrowing) was observed in one patient (0.7%) without clinical consequence. No other complications were observed. Reablation procedures were required in 67 patients (49%). After a mean follow-up of 8.8 卤 5.3 months, 81% of patients were free of AF clinical recurrence, including 66% not taking any antiarrhythmic drugs.

Conclusion: Systematic radiofrequency ablation of PV using an irrigated-tip catheter in patients with atrial fibrillation allows complete isolation of all four PVs with a very low incidence of stenosis.

This is hard to answer exactly without knowing a patient medical history. Amiadorone (spelling?) is generally used, and Warfarin. Sometimes in severe cases of AF pacing would be needed. Generally though you can convert them into normal Sinus Rythim using pharmacological measures. So without knowing more of a history, it is hard to answer this beyond what is noted above.

Atrial Fibrillation can be treated with Coumadin to keep blood clots from going to the lungs. It can also be treated with Radio Frequency Ablation, where parts of the heart muscle are "burned" to keep the electrical signal going where it should. In some cases, a pacemaker is necessary following RFA if the area needing to be burned is in the area of the normal signal.

Low Ejection Fraction is a completely different condition. It may be treated by different medications, depending on other conditions you may have. If your EF is low enough you may qualify for a bi-ventricular pacemaker, where an extra lead is placed so both ventricles are stimulated and the "pump" is once again effective.