Catheter ablation and mortality, stroke and heart failure readmission with atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Previous trials indicated catheter ablation benefits in select atrial fibrillation (AF) and heart failure (HF) patients.
• This study broadens the scope to evaluate ablation's impact in a diverse AF and HF population.

Purpose of the Study:

• To determine the treatment effect of catheter ablation for AF on major adverse events in a wide range of patients with concurrent HF.
• To analyze outcomes based on the chronological order of AF and HF diagnoses.

Main Methods:

• Nationwide administrative registers in Denmark were used to assess the 2-year average treatment effect (ATE).
• The study included two cohorts: patients with AF before HF, and patients with HF before AF.
• Landmark analyses at 1-year and 5-year intervals evaluated a composite endpoint of HF readmission, stroke, and all-cause mortality.

Main Results:

• In the primary cohort (AF before HF), a 1-year ATE reduction of 7.0% for the composite endpoint and 5.8% for all-cause mortality was observed.
• The secondary cohort (HF before AF) showed a 1-year ATE reduction of 11.8% for the composite endpoint and 6.3% for all-cause mortality.
• At 5 years, significant reductions in the composite endpoint and mortality persisted in the primary cohort, but not in the secondary cohort.

Conclusions:

• Catheter ablation for AF in patients with HF is associated with reduced risks of HF readmission, stroke, and all-cause mortality.
• The prognostic benefit of ablation is most substantial in patients diagnosed with AF before HF, particularly when ablation is performed more than one year after both diagnoses.