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Five-year outcomes of catheter ablation in patients with atrial fibrillation and left ventricular systolic
T Jared Bunch1, Heidi T May1, Tami L Bair1
1Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah, USA.
Insights
Catheter ablation for atrial fibrillation (AF) in severe systolic heart failure (SHF) shows common recurrence at 5 years. However, ablation patients had lower mortality and fewer heart failure hospitalizations compared to non-ablated groups.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Catheter ablation is established for symptomatic atrial fibrillation (AF).
- Long-term outcomes and AF recurrence mechanisms in severe systolic heart failure (SHF) patients require further investigation.
- Understanding if 1-year ablation benefits persist is crucial for SHF patients.
Purpose of the Study:
- To evaluate the long-term (5-year) efficacy of catheter ablation for AF in patients with SHF.
- To assess AF recurrence rates, mortality, stroke, heart failure hospitalizations, and cardiac function post-ablation.
- To identify predictors of long-term AF recurrence in this patient population.
Main Methods:
- A 5-year follow-up study matched 267 AF ablation patients with 1,068 AF patients without ablation and 1,068 SHF patients without AF.
- Severe systolic heart failure (SHF) was defined by clinical diagnosis and ejection fraction (EF) ≤35%.
- Primary outcomes included AF recurrence, heart failure, stroke, death, and ejection fraction (EF).
Main Results:
- At 5 years, 60.7% of patients experienced AF recurrence. Diabetes and prior heart attack predicted recurrence.
- Long-term mortality was significantly lower in the AF ablation group (27%) compared to AF (55%) and no AF (50%) groups (P < 0.0001).
- AF ablation was associated with lower heart failure hospitalizations, though ejection fraction (EF) showed no difference. Stroke rates trended lower but were not statistically significant.
Conclusions:
- AF recurrence after catheter ablation is common in SHF patients at 5 years, with ongoing increases anticipated.
- Despite recurrence, AF ablation in SHF patients demonstrated reduced long-term mortality and fewer heart failure hospitalizations.
- Long-term AF-related comorbidities were less frequent in the AF ablation group, suggesting a potential long-term benefit.
Background:
Catheter ablation of atrial fibrillation (AF) is an established therapy for symptomatic patients. The long-term efficacy and impact of catheter ablation among patients with severe systolic heart failure (SHF) requires additional study to understand if outcomes achieved at 1 year are maintained and mechanisms of AF recurrence.
Methods:
Three groups with SHF and 5 years of follow-up were matched 1:4:4 by age (±5 years) and sex: AF ablation patients receiving their first ablation (n = 267), AF patients that did not receive an ablation (n = 1,068), and SHF patient without AF (n = 1,068). SHF was based upon clinical diagnosis and an ejection fraction (EF) ≤35%. Patients were followed for 5-year primary outcomes of AF recurrence, heart failure, stroke, death, and cardiac function.
Results:
At 5 years, 60.7% of patients had clinical recurrence of AF. Diabetes and a prior heart attack were significant predictors of long-term risk of AF recurrence. Long-term mortality rates were 27%, 55%, 50%, in the AF ablation, AF, and no AF groups, respectively (P < 0.0001), with the lower rates attributed to lower cardiovascular mortality. At 5 years, there was no difference in EF, yet HF hospitalizations were lower following AF ablation compared to patients with AF and no ablation. Stroke rates at 5 years trended to be lower in the AF ablation group, but the difference was not statistically significant.
Conclusion:
Recurrence rates of AF in patients with SHF after ablation are common at 5 years with an anticipated ongoing increase. Long-term AF-related comorbidities tended to be less in the AF ablation group.
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