Safety and efficacy of pulmonary vein isolation during acute heart failure hospitalization
J E Marin, O Bastidas, L M Ruiz, C D Nino, J M Aristizabal, W Borja, D Ocampo, A Salazar, N Mejia, B Ramirez, M Duque, N Velez, J S Villamizar, A C Gallo, J DiazAbstract
Introduction
Pulmonary vein isolation (PVI) has been demonstrated to reduce mortality in patients with heart failure (HF) and atrial fibrillation (AF). However, the safety of PVI in patients with acute HF decompensation has not been extensively studied.
Purpose
To determine the efficacy and safety of PVI during hospitalizations for acute HF decompensation (AHFD).
Methods
Patients with HF undergoing PVI between January 2022 and May 2025 were included. All patients underwent PVI using point-by-point radiofrequency ablation under general anesthesia using high-frequency low-tidal volume ventilation, performing wide antral catheter ablation using 40W and an irrigation flow rate of 15 mL/min. All ablations were performed guided by lesion indexes (lesion severity index 5 or ablation index of 550 for the anterior wall and lesion severity index of 4 or ablation index of 400 for the posterior wall), with a targeted interlesion distance of 3mm.
Results
A total of 134 patients (female n=36, age 65±9 years, AHFD n=39) were included (Table 1). Patients with AHFD less frequently had paroxysmal AF (15% vs. 48%, p =0.005), were more frequently diagnosed with new onset HF (31% vs. 8%, p 0.002), had a lower left ventricular ejection fraction (30% vs. 37%, p<0.001), and larger left atrial volumes (56 vs. 47ml/m2, p 0.018). Procedural time was significantly longer (143 vs. 140 min, p 0.03) in patients with acute decompensation; however, there were no cases of pulmonary edema or volume overload. There were 6 procedure-related complications, without significant differences between groups (7% vs. 13% p=0.257): 5 were related to vascular access, with one patient in the no AHFD group presenting with pericardial effusion requiring drainage 1 week after the procedure. After a median follow-up of 441[272-624] days, there were no significant differences in the risk of all atrial arrhythmia recurrence in the AHFD vs the no AHFD groups (HR 0.95, 95% CI 0.31-2.93; Log rank P 0.93)(Figure 1). Significant improvements in LVEF were observed in both groups.
Conclusions
Pulmonary vein isolation can be performed safely in patients hospitalized for acute HF hospitalization, even though patients with AHFD tend to have more severe structural cardiac compromise. During follow-up, there are no significant differences in the risk of all-atrial arrhythmia recurrence between groups, with significant improvements in LVEF in both groups. Given the benefits of PVI in patients with HF, AHFD should not be considered a contraindication to perform PVI.Table 1Figure 1