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Updated: Dec 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter Ablation for Atrial Fibrillation in Patients With Concurrent Heart Failure
Shilpkumar Arora1, Rahul Jaswaney1, Chinmay Jani2
1Harrington Heart and Vascular Institute/Case Western Reserve University, Cleveland, Ohio.
Insights
Catheter ablation for atrial fibrillation did not reduce heart failure readmission or mortality in patients with heart failure. However, catheter ablation significantly reduced atrial fibrillation readmissions in both heart failure with reduced and preserved ejection fraction patients.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation (AF) is a common comorbidity in patients with heart failure (HF).
- Catheter ablation (CA) is a treatment option for AF, but its impact on HF outcomes is not well-established due to limited real-world data.
- Understanding the effectiveness of CA in HF patients is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the impact of catheter ablation (CA) on heart failure (HF) readmission and mortality in patients with co-existing atrial fibrillation (AF).
- To evaluate the effectiveness of CA in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
- To analyze the effect of CA on AF-related readmissions and all-cause readmissions.
Main Methods:
- Retrospective cohort study using the Nationwide Readmissions Database (NRD) from 2016-2017.
- Inclusion of 119,694 patients diagnosed with both AF and HF.
- Propensity score matching (1:15 ratio) was employed to balance patient characteristics, demographics, and comorbidities between CA and non-CA groups.
Main Results:
- Catheter ablation did not significantly reduce the composite outcome of HF readmission and mortality at one year in the overall or propensity-matched HFrEF and HFpEF cohorts.
- CA significantly reduced AF readmissions in both HFrEF (OR 0.41, 95% CI 0.33-0.49) and HFpEF (OR 0.54, 95% CI 0.44-0.65) cohorts.
- While overall mortality and HF readmissions were not reduced, CA led to a significant reduction in any-cause readmissions in the overall HFrEF cohort (OR 0.87, 95% CI 0.82-0.93).
Conclusions:
- Catheter ablation for atrial fibrillation does not improve 1-year mortality or heart failure readmission rates in patients with heart failure, regardless of ejection fraction.
- Catheter ablation is effective in reducing atrial fibrillation-related readmissions in patients with heart failure.
- Further research may be warranted to explore long-term outcomes and specific patient subgroups who might benefit most from catheter ablation in the context of heart failure.
Abstract:
Due to limited real-world data, the aim of this study was to explore the impact of catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF). This retrospective cohort study identified 119,694 patients with AF and HF from the Nationwide Readmissions Database (NRD) from 2016 to 2017. Propensity-matching was generated using demographics, comorbidities, hospital and other characteristics through multivariate logistic regression. Greedy's propensity score match (1:15) algorithm was used to create matched data. The primary end point was a composite of HF readmission and mortality at 1 year. Secondary outcomes include HF readmission, mortality, AF readmission, and any-cause readmission at 1 year. Of the 119,694 patients, 63,299 had HF with reduced ejection fraction (HFrEF), and 56,395 had HF with preserved ejection fraction (HFpEF). In the overall HFrEF cohort, the primary outcome was similar (HR, 95% confidence interval, p-value) (1.01, 0.91 to 1.13, 0.811). AF readmission (0.41, 0.33 to 0.49, <0.001) and any readmission (0.87, 0.82 to 0.93, <0.001) were reduced with CA. In the propensity-matched HFrEF cohort, results were unchanged (primary outcome: 1.10, 0.95 to 1.27, 0.189; AF readmission: 0.46, 0.36 to 0.59, <0.001; any readmission: 0.89, 0.82 to 0.98, 0.015). In the overall HFpEF cohort, the primary outcome was similar (0.90, 0.78 to 1.04, 0.154). AF readmission was reduced with CA (0.54, 0.44 to 0.65, <0.001). In the propensity-matched HFpEF cohort, results were unchanged (primary outcome 1.10, 0.92 to 1.31, 0.289; AF readmission 0.44, 0.33 to 0.57, <0.001). CA did not reduce mortality and HF readmission at one year irrespective of the type of HF, but significantly reduce readmission due to AF.
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