Drs MKIttlesonMD and Mark Link discuss special concerns related to arrhythmias in patients with heart failure. CardioX MedX
I would love to, but first, a disclosure. I ablate, so I'm obviously going to be biased toward ablation. The heart failure group doesn't ablate, and it's taken a few years to convince the heart failure group that ablation works. Let's start with CASTLE-AF. This was a groundbreaking trial of around 360 patients. They were randomized, and they all had systolic heart failure and a BIOTRONIK ICD .
Let's talk about the CABANA trial now. CABANA was for all-comers. It's not a heart failure trial, but a fair percentage of the participants had heart failure with preserved ejection fraction. Very few of them had heart failure with reduced ejection fraction. Patients were randomized to ablation vs the best medical treatment. What happened with this trial is that of the 1000 patients who were randomized to ablation, 100 didn't get ablation, so all they received was medical therapy.
. When should we be looking for it? Should patients be routinely screened for it, and when does it reach the threshold when you should consider ablation?There's been a lot of looking into this, but it's all been retrospective, so there aren't the best data in the world. There appears to be a cut point somewhere between 15% and 20% PVC burden that can cause a cardiomyopathy, and it's causal in those patients because when you ablate the PVCs, the cardiomyopathy gets better.
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