Adverse impact of extensive left atrial ablation on long-term heart failure outcomes in paroxysmal atrial fibrillation
M Ochi, A Sunaga, H Uematsu, S Kato, S Kudo, H Ooka, M MasudaAbstract
Background
Extensive left atrial ablation may impair atrial function; however, its long-term impact on the risk of heart failure (HF) development remains unclear.
Purpose
This study aimed to evaluate the long-term effect of low-voltage area (LVA) ablation on HF outcomes using extended follow-up data from the randomized controlled VOLCANO trial, which assessed the rhythm efficacy of LVA ablation in patients with paroxysmal atrial fibrillation (PAF).
Methods
This analysis included 404 patients who underwent first-time catheter ablation for PAF in the VOLCANO trial and were followed for HF hospitalization for up to 7 years. Patients were categorized into three groups: Group A, no LVA (n = 336); Group B, LVA with ablation (n = 30); and Group C, LVA without ablation (n = 32). Patients with incomplete voltage mapping were excluded from the comparative analyses.
Results
Among 398 patients (median age, 71 [63–77] years; 56% male), 25 experienced HF hospitalization and 20 died during a median follow-up of 1,524 (732–2,594) days. The incidence of HF hospitalization differed significantly among the three groups (P < 0.001; Figure). Notably, HF hospitalization occurred more frequently in Group B than in Group C (30.0% vs. 9.3%, P = 0.032). In multivariable analysis adjusted for baseline clinical variables, LVA ablation was independently associated with an increased risk of HF hospitalization (adjusted hazard ratio, 5.03; 95% confidence interval, 1.10–25.3; P = 0.04).
Conclusions
In patients with PAF and LVA, additional LVA ablation was associated with a significantly higher risk of long-term HF hospitalization. These findings suggest that extensive atrial substrate modification may adversely affect HF prognosis.HF_hospitalizaton_curve.jpg