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Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry

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Abstract

Background

Heart failure (HF) and atrial fibrillation (AF) often coexist, but data on the prognostic value of differing ablation strategies according to left ventricular ejection fraction (LVEF) are rare.

Methods and results

From January 2007 until January 2010, 728 patients with HF were enrolled in the multi-center German ablation registry prior to AF catheter ablation. Patients were divided into three groups according to LVEF: HF with preserved LVEF (≥ 50%, HFpEF, n = 333), mid-range LVEF (40–49%, HFmrEF, n = 207), and reduced LVEF (< 40%, HFrEF, n = 188). Ablation strategies differed significantly between the three groups with the majority of patients with HFpEF (83.4%) and HFmrEF (78.4%) undergoing circumferential pulmonary vein isolation vs. 48.9% of patients with HFrEF. The latter underwent ablation of the atrioventricular (AV) node in 47.3%. Major complications did not differ between the groups. Kaplan–Meier survival analysis demonstrated a significant mortality increase in patients with HFrEF (6.1% in HFrEF vs. 1.5% in HFmrEF vs. 1.9% in HFpEF, p = 0.009) that was limited to patients undergoing ablation of the AV node.

Conclusions

Catheter ablation strategies differ significantly in patients with HFpEF, HFmrEF, and HFrEF. In almost 50% of patients with HFrEF AV-node ablation was performed, going along with a significant increase in mortality rate. These results should raise efforts to further evaluate the prognostic effect of ablation strategies in HF patients.

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Authors and Affiliations

  1. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Charlotte Eitel & Roland R. Tilz

  2. Vivantes Klinika Am Urban und im Friedrichshain und Universitäres Herzzentrum Rostock, Berlin, Germany

    Hueseyin Ince

  3. Klinikum Coburg, Coburg, Germany

    Johannes Brachmann

  4. Asklepios Klinik St. Georg, Hamburg, Germany

    Karl-Heinz Kuck & Roland R. Tilz

  5. Universitäres Herzzentrum, Hamburg, Germany

    Stephan Willems

  6. Deutsches Herzzentrum Berlin, Berlin, Germany

    Jin-Hong Gerds-Li

  7. Helios Klinikum Hildesheim, Hildesheim, Germany

    Juergen Tebbenjohanns

  8. Segeberger KIiniken, Segeberg, Germany

    Gert Richardt

  9. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

Authors
  1. Charlotte Eitel
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  2. Hueseyin Ince
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  3. Johannes Brachmann
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  4. Karl-Heinz Kuck
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  5. Stephan Willems
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  6. Jin-Hong Gerds-Li
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  7. Juergen Tebbenjohanns
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  8. Gert Richardt
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  9. Matthias Hochadel
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  10. Jochen Senges
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  11. Roland R. Tilz
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Correspondence to Charlotte Eitel.

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Eitel, C., Ince, H., Brachmann, J. et al. Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry. Clin Res Cardiol 108, 815–823 (2019). https://doi.org/10.1007/s00392-019-01411-3

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  • DOI: https://doi.org/10.1007/s00392-019-01411-3

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