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Incidence and Predictors of New-Onset Heart Failure After Catheter Ablation for Atrial Fibrillation in Patients With
Masahiro Hisaoka1, Yasuhiro Yoshiga1, Hironori Ishiguchi1
1Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine Yamaguchi Japan.
Insights
New-onset heart failure (HF) is uncommon after atrial fibrillation (AF) ablation in patients with preserved ejection fraction. However, durable rhythm control after AF ablation may reduce HF risk.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- The risk of new-onset heart failure (HF) following catheter ablation for atrial fibrillation (AF) is not well understood, especially in patients with preserved ejection fraction (EF ≥50%) and no prior history of HF.
- Understanding these predictors is crucial for patient selection and risk stratification.
Purpose of the Study:
- To investigate the incidence and predictors of new-onset HF after AF ablation in patients with preserved EF and no prior HF.
- To evaluate the association between early and late recurrence of atrial tachyarrhythmias (ATs) and subsequent HF development.
Main Methods:
- Retrospective analysis of 480 patients with EF ≥50% and no prior HF undergoing initial AF ablation.
- Landmark analyses at 3 and 12 months to identify HF predictors.
- Time-dependent Cox proportional hazards model to assess the impact of AT recurrence after final ablation on HF development.
Main Results:
- New-onset HF occurred in 3.75% of patients during a median follow-up of 70 months.
- Age >75 years was the only consistent independent predictor of new-onset HF in landmark analyses.
- Recurrence of ATs after the final ablation was independently associated with a 4-fold increased risk of new-onset HF (HR 4.028; P=0.004).
Conclusions:
- New-onset HF after AF ablation is infrequent in patients with preserved EF and no prior HF but carries clinical significance.
- Achieving durable rhythm control post-ablation appears critical for mitigating the risk of HF development.
Background:
The incidence and predictors of new-onset heart failure (HF) after catheter ablation for atrial fibrillation (AF) remain unclear, particularly in patients with preserved left ventricular ejection fraction (EF ≥50%) and no prior HF.
Methods And Results:
We retrospectively analyzed 480 consecutive patients with EF ≥50% and no prior HF who underwent initial AF ablation. Recurrent atrial tachyarrhythmias (ATs) and new-onset HF were assessed during follow up. Landmark analyses at 3 and 12 months after the first procedure were performed to evaluate predictors of new-onset HF and the association between recurrence of early ATs and subsequent HF. Additionally, recurrence of ATs after the final ablation was examined as a time-dependent covariate using a Cox proportional hazards model. During a median follow up of 70 months (interquartile range 60-84 months), 18 (3.75%) patients developed new-onset HF. Age >75 years was the only consistent independent predictor in both landmark analyses. Early recurrence of ATs within 3 or 12 months was not associated with HF development. However, recurrence of ATs after the final procedure was independently associated with new-onset HF in a time-dependent analysis (hazard ratio 4.028; 95% confidence interval 1.564-10.378; P=0.004).
Conclusions:
In patients with preserved EF and no prior HF, new-onset HF after AF ablation was uncommon but clinically relevant. Durable rhythm control may be important to reduce HF risk.
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