Abstract:

Background: Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of heart failure (HF) patients with AF. However, its optimal timing remains to be fully elucidated.

Objectives: This study aimed to investigate the prognostic impact of early CA in patients with HF and AF hospitalized due to worsening HF.

Methods: From the Japanese Registry of Acute Decompensated Heart Failure (JROADHF; n=13,238), we identified HF patients with AF who underwent CA within 90 days after admission for HF (early CA; n=103) and those who did not (control; n=2,683). Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n=83 in each group).

Results: In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank: p<0.001, hazard ratio (HR) [95%CI]: 0.38 [0.24-0.60]). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank: p=0.014, HR [95%CI]: 0.47 [0.25-0.88]). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray' test: p<0.001 and p=0.005, subdistribution HR [95%CI]: 0.28 [0.13-0.63] and 0.31 [0.13-0.75]; matched: Gray's test: p=0.006 and 0.017, sub-distribution HR [95%CI]: 0.24 [0.08-0.70] and 0.28 [0.09-0.84], respectively).

Conclusions: In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in HF patients with AF

Editor-in-Chief

Kalyanam Shivkumar, MD, PhD, FACC 

CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, MD, FACC

Important Dates
Date of Release: September 25, 2023
Term of Approval/Date of CME/MOC Expiration: September 24, 2024