Early catheter ablation for atrial fibrillation in acute heart failure: prognostic impact across age and ejection fraction
A Okahara, S Kawai, M Tokutome, H Matsuura, T Iwasaki, Y Kuroki, Y Koga, T Masunaga, T Tamamoto, T Sakemi, S Ikeda, Y Oga, Y MukaiAbstract
Background
Atrial fibrillation (AF) frequently complicates acute decompensated heart failure (HF) and is associated with increased mortality and recurrent hospitalization. Although catheter ablation (CA) has demonstrated prognostic benefit in selected HF populations, its impact when performed early after hospitalization for acute HF remains uncertain, particularly in elderly patients and those with preserved ejection fraction (EF), who are underrepresented in randomized trials. We aimed to evaluate the prognostic impact of early CA across age and EF strata in a real-world cohort of patients hospitalized with acute HF and AF.
Methods
We retrospectively analyzed 400 consecutive patients admitted for acute HF with AF between 2019 and 2022 at a tertiary cardiovascular center. Patients were stratified according to treatment strategy: those who underwent CA within 3 months after discharge (CA group) and those managed with optimal medical therapy alone (OMT group). The primary endpoint was a composite of all-cause mortality and HF readmission at 2 years. Outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards models. To minimize selection bias, propensity score matching was performed, yielding 54 well-balanced pairs. Prespecified subgroup analyses were conducted according to age (≥75 vs. <75 years) and EF (<40% vs. ≥40%).
Results
During 2-year follow-up, crude analyses demonstrated that the CA group had significantly lower all-cause mortality compared with the OMT group (Figure A). Crude HF readmission rates were also significantly reduced in patients who underwent early CA (Figure B). In crude analyses of the composite endpoint, early CA was associated with significant risk reduction across age categories, with consistent benefit observed in both patients aged ≥75 years and those <75 years (Figure C). Similarly, EF-stratified crude analyses showed that CA significantly reduced the composite endpoint in both patients with reduced EF (<40%) and those with EF ≥40% (Figure D). After propensity score matching, these findings remained consistent. In the matched cohort, early CA continued to show significant reduction in the composite endpoint across both age strata (Figure E). Likewise, EF-based analyses after matching confirmed that CA conferred significant prognostic benefit irrespective of systolic function (Figure F).
Conclusion
Early catheter ablation within 3 months following hospitalization for acute HF was associated with significant reduction in 2-year mortality and HF readmission. The prognostic benefit was consistently observed across elderly and non-elderly patients as well as across reduced and preserved EF. These findings support early rhythm control with CA as a potentially effective strategy in a broad spectrum of patients with acute HF and AF.figure