DOI: 10.1161/circ.148.suppl_1.12398 ISSN: 0009-7322

Abstract 12398: Prognostic Impact of Early Ablation in Patients With Decompensated Heart Failure Accompanied by Atrial Fibrillation

Arihide Okahara, Shunsuke kawai, Masaki Tokutome, Hirohide Matsuura, kosuke okabe, Masashi Sada, Junpei Itonaga, Eiichi Koga, Hiroshi Kisanuki, Ayano Hara, Kiyohiro Ogawa, Ryuichi Matsukawa, Yasushi Mukai
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, which leads to worse clinical outcomes. Catheter ablation (CA) of AF in younger patients with HF with reduced EF (HFrEF) has become an established treatment option. However, clinical impact of early CA of AF in patients hospitalized for acute decompensated heart failure (ADHF) is uncertain.

Hypothesis: This study aims to investigate the prognostic impact of early CA of AF in patients who were hospitalized for ADHF.

Methods: Consecutive 234 patients with ADHF requiring in-hospital care accompanying with AF were retrospectively analyzed 2 years after discharge. Patients who underwent CA within 3 months after HF admission (CA group; n=51) and those who did not (optimal medical therapy [OMT] group; n=183) were compared with regards to clinical outcomes.

Results: The median age of the studied population was 83 year-old; 72±12 in the CA group and 84±9 in the OMT group. Persistent AF was observed in 92.2% in the CA group and 63.9% in the OMT group. During 2 years after admission, recurrence of AF was observed in 19.6% in the CA group and 82.0% in the OMT group. In the crude study, all-cause mortality and HF mortality were significantly lower in the CA group than in the OMT group (all-cause: hazard ratio (HR) [95%CI]: 0.07 [0.01-0.53], p=0.00074; HF: HR 0.19 [0.07-0.48], p=0.000078; respectively) (Figure A and Figure B). Since the OMT group had severer characteristics including age, sex or NYHA class, a propensity-matched analysis was performed (n=33, each group). All-cause mortality tended to be lower in the CA group (HR 0.19 [0.02-1.67], p=0.13) (Figure C), however, it did not reach to a statistical significance. On the other hand, HF readmission rate was still significantly lower in the CA group even after the propensity-matched analysis (HR 0.17 [0.04-0.59], p=0.0054) (Figure D).

Conclusions: CA of AF early after ADHF admission was associated with a better long-term prognosis in patients with HF and AF.

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