Long‐Term Outcomes of AV Node Ablation Plus CRT Compared to AF Catheter Ablation in Patients With AF and HFrEF
Abhiram Challa, Sittinun Thangjui, Amro Taha, Harsh Patel, Tejasri Polana, Het Patel, Saim Rana, Angkawipa Trongtorsak, Natee Deepan, David Schwartzman, Sandeep AroraABSTRACT
Background
Catheter ablation is an established rhythm‐control strategy for atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), while atrioventricular node ablation with cardiac resynchronization therapy (AVNA+CRT) is often used in older patients with advanced disease when durable rhythm control is less feasible. Comparative long‐term outcomes remain unclear.
Methods
Using the TriNetX Research Network, we identified adults with HFrEF and AF from 2016 who underwent AF ablation or AVNA+CRT from 2016–2023 and 2016–2020 for the 2‐ and 5‐year analysis, respectively. Propensity score matching was performed separately using 58 prespecified covariates. Outcomes included embolic events (stroke/systemic embolism), all‐cause mortality, heart failure (HF) hospitalization, and heart transplant/left ventricular assist device (LVAD) implantation.
Results
The 2‐year cohort included 16,276 patients (2899 AVNA+CRT; 13,377 AF ablation); the 5‐year cohort included 7370 patients (1463 AVNA+CRT; 5907 AF Ablation). After matching, AVNA+CRT was associated with higher all‐cause mortality (RR 1.580, 95% CI 1.389–1.799), HF hospitalization (RR 1.106, 95% CI 1.040–1.176), and heart transplant/LVAD implantation (RR 2.381, 95% CI 1.142–4.975), with no difference in embolic events at 2 years. At 5 years, AVNA+CRT remained associated with higher mortality (RR 1.350, 95% CI 1.198–1.522; p < 0.001), while HF hospitalization, embolic events, and heart transplant/LVAD implantation did not differ significantly.
Conclusion
In a large propensity matched HFrEF‐AF cohort, AVNA+CRT was associated with higher mortality at 2 and 5 years than AF ablation, with excess HF hospitalization and transplant/LVAD at 2 years, whereas HF hospitalization rates were similar at 5 years. Prospective studies are needed to refine patient selection in older, medically complex patients.