Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction

Abstract

Background Atrial fibrillation (AF) is associated with heart failure (HF) rehospitalization in patients with heart failure with preserved ejection fraction (HFpEF). Objective We tested the hypothesis that catheter ablation of AF could reduce HF rehospitalization compared with conventional pharmacotherapy in patients with HFpEF. Methods Eighty‐five consecutive HFpEF (EF ≥ 50% and a history of HF hospitalization) patients diagnosed as AF by 12‐lead electrocardiogram were retrospectively analyzed. Thirty‐five patients who received catheter ablation (ABL group) were compared with 50 patients treated by antiarrhythmic drugs and/or beta‐blockers (CNT group). The primary endpoint was rehospitalization due to HF. Results The patients characteristics did not differ between the two groups including, age (71 ± 8 vs 71 ± 13 years; P = .637), female sex (34% vs 36%; P = .870), mean plasma brain natriuretic peptide (145 ± 112 vs 195 ± 153 pg/mL; P = .111), mean left ventricular ejection fraction (62% ± 8% vs 61% ± 9%; P = .624), and type of AF (nonparoxysmal AF 60% vs 62%; P = .852). Amiodarone was continued 40% (14 out of 35) and 40% (20 out of 70) in ABL and CNT groups, respectively (P = 1.000). Neither major complication nor major side effect was observed during the follow‐up period. During a mean follow‐up period of 792 ± 485 days, Kaplan‐Meier curve analysis showed that significantly more patients in the ABL group were free from HF rehospitalization (log‐rank P = .0039). Additionally, multivariate analysis revealed that catheter ablation of AF was the only preventive factor of HF rehospitalization (OR = 0.15; 95% CI: 0.04‐0.46; P < .001). Conclusions Catheter ablation of AF reduced HF rehospitalization compared with conventional pharmacotherapy in patients with HFpEF in our institute. Multicenter randomized study is warranted to confirm the result.

Atrial fibrillation ablation in congestive heart failure with preserved ejection fraction: Tackling the vicious twins

“…8 Interestingly, none of the 27 patients in the ABL group who maintained sinus rhythm had HF hospitalization during follow-up and no major complication was observed with AF ablation in this relatively small group of patients. 8 Presented as one of the pioneering retrospective studies reporting the impact of catheter ablation of AF on reducing HF rehospitalization in AF-HFpEF, the authors should be congratulated for moving the needle forward in this field. As promising as the results seem, they should be examined carefully and placed in perspective.…”

“…8 Although no statistically significant increase in sinus rhythm maintenance was seen in the ABL group (P = .119), multivariate analysis revealed that AF ablation was the only preventive factor for HF rehospitalization (odds ratio = 0.15; P < .001). 8 Interestingly, none of the 27 patients in the ABL group who maintained sinus rhythm had HF hospitalization during follow-up and no major complication was observed with AF ablation in this relatively small group of patients. 8 Presented as one of the pioneering retrospective studies reporting the impact of catheter ablation of AF on reducing HF rehospitalization in AF-HFpEF, the authors should be congratulated for moving the needle forward in this field.…”

“…7 Nonetheless, despite early promising results, there has been concern that AF ablation in AF-HFpEF may carry a lower success rate and a potentially higher focal ablation for atrial tachycardia/nonpulmonary vein focus, superior vena cava ablation, and cavotricuspid isthmus linear ablation at the discretion of the operators. 8 The primary outcome was rehospitalization due to HF. During a mean follow-up of 792 days, more patients in the ABL group were free from HF hospitalization (P = .039).…”

“…8 The study design excluded patients with a significant left atrial enlargement (left atrial diameter > 55 mm). 8 From the HF perspective, diagnosis of HFpEF was primarily based on clinical diagnosis of HF and echo evidence of LVEF ≥ 50%. 8 Overall, patients included in this study were consistent with current guideline recommendations for AF and HFpEF diagnoses and reasonably representative of this patient population.…”

“…8 From the HF perspective, diagnosis of HFpEF was primarily based on clinical diagnosis of HF and echo evidence of LVEF ≥ 50%. 8 Overall, patients included in this study were consistent with current guideline recommendations for AF and HFpEF diagnoses and reasonably representative of this patient population. One caveat is that a few patients with hypertrophic cardiomyopathy were included, which are not typically categorized as…”