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Early Ablation for Atrial Fibrillation After Admission for Heart Failure
Quick Takes
- In a cohort study of Japanese patients with heart failure (HF) and atrial fibrillation (AF), all-cause mortality was significantly lower in the early catheter ablation group than in the control group.
- A propensity-matched cohort of HF patients with AF had a significantly lower all-cause mortality in the early ablation group.
Study Questions:
What is the prognostic impact of early catheter ablation in patients with heart failure (HF) and atrial fibrillation (AF) hospitalized due to worsening HF?
Methods:
The authors used the Japanese Registry of Acute Decompensated Heart Failure (n = 13,238) to identify HF patients with AF who underwent catheter ablation within 90 days after admission for HF (early ablation; 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 catheter ablation group than in the control group (log-rank, p < 0.001; hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.24–0.60). In the propensity-matched cohort, all-cause mortality was also significantly lower in the early ablation group (log-rank, p = 0.014; HR, 0.47; 95% CI, 0.25–0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts.
Conclusions:
In this nationwide cohort of Japanese patients with HF and AF, ablation for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death.
Perspective:
AF and HF are common comorbidities, and clinical outcomes of patients with both conditions are worse than the patients with either disease alone. With few drug options having a neutral effect on mortality, and ablation being superior to even amiodarone in HF patients, ablation has emerged as a potential breakthrough in these patients. The previously published CASTLE-AF (Catheter Ablation for Atrial Fibrillation With Heart Failure) trial showed that catheter ablation for AF in patients with severe HF reduces hospitalization and mortality. Additional studies have shown similar findings. The authors of the present retrospective, nonrandomized, cohort study show that ablation within 3 months of HF admission was associated with reduced long-term mortality, as well as cardiovascular and HF death. Future studies will be needed to confirm these findings and to attempt to identify the most optimal timing for AF ablation in HF patients.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Heart Failure
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