Related Experiment Video
Updated: Jun 15, 2025
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
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.
Insights
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.
Background:
Catheter ablation (CA) improves clinical outcomes in patients with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to evaluate the impact of CA on clinical and quality-of-life outcomes across HF subtypes.
Methods:
All patients undergoing AF ablation at a tertiary center were enrolled in a prospective registry and included in this study (2013-2021). The primary end point was AF recurrence. Secondary end points included AF-related hospitalizations and quality-of-life outcomes. Patients were categorized according to their HF status: no HF, HFrEF, HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF).
Results:
A total of 7020 patients were included (80% no HF, 8% HFrEF, 7% HFmrEF, and 5% HFpEF). Over 3 years, the cumulative incidence of AF recurrence after ablation was as follows: HFpEF (53%), HFmrEF (41%), HFrEF (41%), and no HF (34%); P<0.01. Multivariable Cox analyses confirmed these findings using no HF group as reference (HFpEF: hazard ratio, 1.47 [95% CI, 1.21-1.78]; HFmrEF: hazard ratio, 1.23 [95% CI, 1.04-1.45]; and HFrEF: hazard ratio, 1.17 [95% CI, 1.01-1.37]; P<0.05 for all). In all groups, CA resulted in a significant reduction of AF-related hospitalization (mean rate per 1 patient-years [before and after CA]; HFpEF [1.8 versus 0.3], HFmrEF [1.1 versus 0.2], HFrEF [1.1 versus 0.2], and no HF [1 versus 0.1]; P<0.01 for each comparison) and significant improvement in quality of life as measured by both the AF symptom severity score and the AF burden score (P<0.01 for the comparison between baseline and follow-up for each score when tested separately).
Conclusions:
AF recurrence rates after CA were higher in patients with HF compared with those without HF, with patients with HFpEF being at the highest risk of recurrence. Nonetheless, CA was associated with a significant reduction in AF symptoms, AF-related hospitalization, and HF symptoms in most patients irrespective of HF subtypes.
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:22Heart Failure Drugs: Diuretics
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers