Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology

• Published in: Journal of arrhythmia Vol. 36; no. 1; pp. 84 - 92
• Main Authors: Black‐Maier, Eric, Steinberg, Benjamin A., Trulock, Kevin M., Wang, Frances, Lokhnygina, Yuliya, O'Neal, Wanda, Al‐Khatib, Sana, Atwater, Brett D., Daubert, James P., Frazier‐Mills, Camille, Hegland, Donald D., Jackson, Kevin P., Jackson, Larry R., Koontz, Jason I., Lewis, Robert K., Sun, Albert Y., Thomas, Kevin L., Bahnson, Tristram D., Piccini, Jonathan P.
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.02.2020; John Wiley and Sons Inc; Wiley
• Subjects: Ablation; Ablation (Surgery); Atrial fibrillation; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Care and treatment; catheter ablation; Catheters; Causes and theories of causation; Comparative analysis; Coronary vessels; Development and progression; Diseases; Dofetilide; Ejection fraction; Etiology; Heart; Heart failure; Hospitals; Medical research; Medicine, Experimental; Original; outcomes; Patients; Quality of life; Sleep apnea; heart failure; atrial fibrillation; catheter ablation; cardiomyopathy; outcomes
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12291

Background Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs nonischemic heart failure. Methods We conducted a retrospective, observational cohort study of patients with HF who underwent AF ablation. Outcomes were compared based on HF etiology and included in‐hospital events, symptoms (Mayo AF Symptom Inventory [MAFSI]), and functional status (New York Heart Association class) and freedom from atrial arrhythmias at 12 months. Results Among 242 patients (n = 70 [29%] ischemic, n = 172 [71%] nonischemic), patients with nonischemic cardiomyopathy were younger (mean age 64 ± 11.5 vs 69 ± 9.1, P = .002), more often female (36% vs 17%, P = .004), and had higher mean left‐ventricular ejection fraction (47% vs 42%, P = .0007). There were no significant differences in periprocedural characteristics, including mean procedure time (243 ± 74.2 vs 259 ± 81.8 minutes, P = .1) and nonleft atrial ablation (17% vs 20%, P = .6). All‐cause adverse events were similar in each group (15% vs 17%, P = .7). NYHA and MAFSI scores improved significantly at follow‐up and did not differ according to HF etiology (P = .5; P = .10‐1.00 after Bonferroni correction). There were no significant differences in freedom from recurrent atrial arrhythmia at 12‐months between ischemic (74%) and nonischemic patients (78%): adjusted RR 0.63, 95% confidence interval 0.33‐1.19. Conclusions Catheter ablation in patients with AF and concomitant heart failure leads to significant improvements in functional and symptom status without significant differences between patients with ischemic vs nonischemic HF etiology. Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic versus nonischemic heart failure. We found that catheter ablation in patients with AF and concomitant heart failure leads to significant improvements in functional and symptom status without significant differences between patients with ischemic versus nonischemic HF etiology.