Elsevier

The American Journal of Cardiology

Volume 137, 15 December 2020, Pages 45-54
The American Journal of Cardiology

Catheter Ablation for Atrial Fibrillation in Patients With Concurrent Heart Failure

https://doi.org/10.1016/j.amjcard.2020.09.035Get rights and content

Highlights

  • Real-world data is limited for catheter ablation (CA) in Afib (AF) and heart failure (HF).

  • CA had no significant change in mortality and morbidity in AF with HFrEF at 1 year.

  • CA had no significant change in mortality and morbidity in AF with HFpEF at 1 year.

  • There may be a role for CA in reducing the burden AF related hospitalization

Due to limited real-world data, the aim of this study was to explore the impact of catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF). This retrospective cohort study identified 119,694 patients with AF and HF from the Nationwide Readmissions Database (NRD) from 2016 to 2017. Propensity-matching was generated using demographics, comorbidities, hospital and other characteristics through multivariate logistic regression. Greedy's propensity score match (1:15) algorithm was used to create matched data. The primary end point was a composite of HF readmission and mortality at 1 year. Secondary outcomes include HF readmission, mortality, AF readmission, and any-cause readmission at 1 year. Of the 119,694 patients, 63,299 had HF with reduced ejection fraction (HFrEF), and 56,395 had HF with preserved ejection fraction (HFpEF). In the overall HFrEF cohort, the primary outcome was similar (HR, 95% confidence interval, p-value) (1.01, 0.91 to 1.13, 0.811). AF readmission (0.41, 0.33 to 0.49, <0.001) and any readmission (0.87, 0.82 to 0.93, <0.001) were reduced with CA. In the propensity-matched HFrEF cohort, results were unchanged (primary outcome: 1.10, 0.95 to 1.27, 0.189; AF readmission: 0.46, 0.36 to 0.59, <0.001; any readmission: 0.89, 0.82 to 0.98, 0.015). In the overall HFpEF cohort, the primary outcome was similar (0.90, 0.78 to 1.04, 0.154). AF readmission was reduced with CA (0.54, 0.44 to 0.65, <0.001). In the propensity-matched HFpEF cohort, results were unchanged (primary outcome 1.10, 0.92 to 1.31, 0.289; AF readmission 0.44, 0.33 to 0.57, <0.001). CA did not reduce mortality and HF readmission at one year irrespective of the type of HF, but significantly reduce readmission due to AF.

Section snippets

Methods

Nationwide readmission database (NRD) from the year 2016–2017 was utilized to derive the study cohort. NRD is a subset of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality. NRD from year 2016–17 contains data from approximately 17 million discharges, across 28 geographically dispersed states, accounts for 60% of the total US resident population and 58.2% of all US hospitalizations.12 NRD was studied and validated in multiple previous

Results

Our study included a total of 119,694 patients from the year 2016–2017 with AF and comorbid HF, in which 63,299 had HFrEF and 56,395 had HFpEF. Of the patients with AF and concomitant HFrEF or HFpEF, 2,841(4.5%) and 1,790 (3.2%) patients respectively underwent AF ablation (Table 1).

In the HFrEF cohort, 42.6% of patients were ≥75 years and 40.2% of patients were female. The most common comorbidities were hypertension (81.4%), CAD (50.2%), diabetes (32.1%), CKD stage 3 or more (27.5%), and COPD

Discussion

In this real-world report of patients with AF and co-morbid HF, the patients who underwent catheter ablation did not demonstrate significant improvement in the primary outcome of all-cause mortality and HF hospitalization when compared with patients who did not receive ablative therapy. AF readmission rates at the end of 1 year were significantly less in patients that underwent catheter ablation in HFrEF and HFpEF. All-cause readmission rates in patients with HFrEF that received ablation were

Author Contributions

Dr. S. Arora: Conceptualization, methodology, software, formal analysis, writing – review and editing, project administration; Dr. Jaswaney: Writing – original draft, writing review- and editing, project administration; Dr. Jani: formal analysis, software; Dr. Zuzek: Writing- original draft, writing- review and editing; Dr. Thakkar: writing – original draft; Dr. H Patel: project administration; Ms. M Patel: visualization, project administration; Dr. N Patel: Project administration; Dr.

Disclosures

The authors of this manuscript have no relevant conflicts of interest to report.

Acknowledgment

There are no further acknowledgements to this paper.

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    Authors contributed equally to manuscript.

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