Elsevier

The American Journal of Cardiology

Volume 189, 15 February 2023, Pages 108-118
The American Journal of Cardiology

Atrial Fibrillation Ablation Outcomes and Heart Failure (from the Kansai Plus Atrial Fibrillation Registry)

https://doi.org/10.1016/j.amjcard.2022.11.038Get rights and content

The impact of rhythm outcomes on heart failure (HF) hospitalizations remains unknown after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). We sought to elucidate whether AF recurrence was associated with HF hospitalizations after AF RFCA. We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry), enrolling 5,010 consecutive patients (age 64 ± 10 years, 27.3% female, and 35.7% nonparoxysmal AF) who underwent an initial AF RFCA at 26 centers. The median follow-up duration was 2.9 years. The cumulative 3-year incidence of HF hospitalizations after the initial RFCA was 1.84% (0.69%/year). Hospitalized patients with HF were older with a higher prevalence of nonparoxysmal AF, renal dysfunction, diabetes, and underlying heart disease pre-RFCA. HF hospitalizations occurred more often in patients with than without recurrences (3.27 vs 0.84%, log-rank p <0.0001). After adjusting for confounders using a Cox model, AF recurrence remained an independent predictor of HF hospitalizations (hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.80 to 4.47, p <0.0001). AF recurrence was a distinct HF hospitalization risk in patients with a left ventricular ejection fraction ≥50% (HR 4.54, 95% CI 2.38 to 8.65, p <0.0001) but not <50% (HR 1.31, 95% CI 0.65 to 2.62, p = 0.45), with significant interactions. Furthermore, patients with AF recurrences within 1 year had a greater HF hospitalization risk after 1 year (1.61% vs 0.79%, log-rank p = 0.019). In conclusion, AF recurrence after RFCA was independently associated with HF hospitalizations.

Section snippets

Methods

The KPAF (Kansai Plus Atrial Fibrillation) Registry is a multicenter, observational study, recruiting patients from 26 cardiovascular centers primarily located in the Kansai region of Japan between November 2011 and March 2014 and enrolled 5,010 consecutive patients who underwent a first-time RFCA of AF (UMIN000006127).9 The study protocol was approved by the institutional review board at each participating center.

Vaughan Williams class I or III antiarrhythmic drugs (AADs) were primarily

Results

The baseline characteristics of the total 5,010 enrolled patients divided into those with or without an HF hospitalization after the index RFCA are shown in Table 1. During a 2.92-year mean follow-up, 98 of 5,010 patients (1.96%) experienced a hospitalization for HF after the index RFCA. Patients with HF hospitalizations compared with those without were older (with HF hospitalizations vs without HF hospitalizations, 69.0 ± 10.5 vs 64.3 ± 10.4, respectively, p <0.0001), had a lower body mass

Discussion

The present analysis of the KPAF Ablation Registry of 5,010 patients after the initial RFCA of AF during the 3-year follow-up revealed the following findings: (1) the 3-year cumulative incidence of HF hospitalizations was 1.84% (0.69%/year) after the index RFCA in this real-world registry. (2) AF recurrence was independently associated with HF hospitalizations after the index RFCA (HR 2.84, 95% CI 1.80 to 4.47, p <0.0001) and that was consistent in almost all subgroups, except in the patient

Disclosures

Dr. Inoue has received honoraria from Johnson and Johnson KK and Medtronic, Inc.

Dr. Tanaka has received honoraria from Johnson and Johnson KK. The remaining authors have no conflicts of interest to declare.

Acknowledgment

The authors thank the clinical research coordinators from the study management center for their invaluable help in checking and correcting the enormous data. The authors also thank John Martin, BSc and Danny H.- K. Jokl, MD for their linguistic assistance with the manuscript.

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  • This study was supported by the Research Institute for Production Development in Kyoto, Japan.

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