Arrhythmia-Free Survival After Catheter Ablation for Atrial Fibrillation Comparable for HFpHF and HFrEF

Arrhythmia-free survival after catheter ablation for atrial fibrillation was comparable in patients with heart failure (HF) with preserved and reduced ejection fraction, according to a study published in the American Journal of Cardiology.

A total of 547 patients undergoing catheter ablation between 2009 and 2015 were recruited for this observational, retrospective cohort study. Left ventricular ejection fraction (EF) ³50% and <50% were considered as HF with preserved (HFpEF) and reduced EF (HFrEF), respectively. All procedures were performed under general anesthesia, with intravenous heparin, and using electroanatomic mapping systems. Pulmonary vein blocks were confirmed using a circular catheter. Patients were followed for any adverse events after the procedure.

In this cohort, 83% of participants did not have HF at the time of the procedure. HFpEF was more frequent than HFrEF (9& vs 7%, respectively). At baseline, patients with HFpEF and HFrEF differed significantly for: type of atrial fibrillation (P <.001), CHA₂DS₂VASc score (P <.001), rate of hypertension (P =.004), chronic obstructive pulmonary disease (P <.001), sleep apnea (P =.033), coronary artery disease (P <.001), end stage renal disease (P =.003), and implanted coronary devices (P <.001).

The duration of the ablation procedure was longer among patients with HF (HFpEF: median, 277 min; interquartile range [IQR], 229-331 min; HFrEF: median, 266 min; IQR, 226-300 min) compared with patients without HF (median, 240 min; IQR, 200-282 min; P <.001). Patients with vs without HF were more likely to require a left atrial roof line (HFpEF: 36%; HFrEF: 46% vs 23%; P =.001, respectively).

The follow-up time was longer for participants with HFpEF compared with those with HFrEF or without HF (median: 50.9 months; 24.2 months; and 31.3 months, respectively; P =.027). Patients with HFpEF were more likely to undergo repeat ablation than those with HFrEF (51% vs 28%, respectively; P =.036).

Following the procedure, 63% of participants with HFpEF, 50% of those with HFrEF, and 56% of those without HF did not require antiarrhythmic drugs. Recurrence rates at 5 years were comparable for patients on or off antiarrhythmic drugs (P =.205 and P =.053, respectively).

At 5 years, all-cause hospitalizations were lower in the group without HF compared with the HFpEF or HFrEF groups (55% vs 76%; P <.001 vs 67%; P =.039, respectively). No significant difference in survival was observed (HFpEF, 95%%; HFrEF, 87%; no HF, 96%; P =.604).

A major limitation of this study is the small number of participants with HF. The fact that the investigators failed to detect significant differences may have been due in part to type II errors.

“[C]atheter ablation of [atrial fibrillation] appears safe and effective in patients with HF, regardless of the presence of systolic or diastolic left ventricular dysfunction,” concluded the study authors. “There were no significant differences in recurrence of atrial arrhythmias and rates of procedural complications, all-cause hospitalizations and mortality between patients with HFpEF and HFrEF.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Aldaas O M, Malladi C L, Mylavarapu P S, et al. Comparison of outcomes after ablation of atrial fibrillation in patients with heart failure with preserved versus reduced ejection fraction. Am J Cardiol. 2020;S0002-9149(20)30956-5. doi:10.1016/j.amjcard.2020.09.0