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Outcomes of Atrial Fibrillation Ablation in Heart Failure Subtypes
Arwa Younis1, Chadi Tabaja1, Pasquale Santangeli2
1Department of Cardiovascular Medicine (A.Y., C.T., H.N., P.B., D.O.M., S.N., M.K., J. Sroubek, J.Z.L.), Cleveland Clinic, OH.
Circulation. Arrhythmia and Electrophysiology
|August 28, 2024
Summary
Catheter ablation (CA) for atrial fibrillation (AF) shows higher recurrence in heart failure (HF) patients, especially HF with preserved ejection fraction (HFpEF). However, CA significantly reduces AF symptoms and hospitalizations across all HF subtypes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Catheter ablation (CA) is a key treatment for atrial fibrillation (AF).
- Its impact on patients with co-existing heart failure (HF) requires further investigation across different HF classifications.
- Heart failure with reduced ejection fraction (HFrEF) is a known complication of AF, but outcomes across all HF subtypes post-ablation are less understood.
Purpose of the Study:
- To evaluate the effectiveness of catheter ablation (CA) in managing atrial fibrillation (AF) across various heart failure (HF) subtypes.
- To assess the impact of CA on clinical outcomes, including AF recurrence and hospitalizations.
- To determine the effect of CA on quality-of-life metrics in patients with and without HF.
Main Methods:
- A prospective registry of 7020 patients undergoing AF ablation between 2013-2021 was analyzed.
- Patients were stratified into four groups: no HF, HFrEF, HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF).
- Primary endpoint was AF recurrence; secondary endpoints included AF-related hospitalizations and quality-of-life scores.
Main Results:
- AF recurrence rates after CA were higher in patients with HF (34% in no HF to 53% in HFpEF).
- Patients with HFpEF had a 47% higher risk of AF recurrence compared to those without HF (HR 1.47).
- CA significantly reduced AF-related hospitalizations and improved quality of life across all HF groups.
Conclusions:
- Catheter ablation for AF is associated with increased recurrence rates in patients with heart failure, particularly those with HFpEF.
- Despite higher recurrence, CA offers significant benefits in reducing AF symptoms, hospitalizations, and improving quality of life for patients with AF, irrespective of their HF classification.
- Risk stratification for AF recurrence post-ablation should consider HF status, with HFpEF patients requiring closer monitoring.
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