Clinical outcomes and structural remodelling after ablation of atrial fibrillation in heart failure with mildly reduced or mid‐range ejection fraction

Abstract

AimsThe efficacy of catheter ablation (CA) on clinical outcomes and cardiac structural remodelling in atrial fibrillation (AF) patients with HF with mildly reduced or mid-range ejection fraction (HFmrEF) remains unclear. We aimed to compare the efficacy of CA with medical therapy (MT) in AF patients with HFmrEF. Methods and resultsWe retrospectively screened a total of 36 879 patients with AF between 2005 and 2020. Patients who were initially diagnosed with echocardiography-proved HFmrEF and had follow-up echocardiography were enrolled. After applying propensity score matching in a 1:1 ratio, 72 patients treated by CA (Group 1) and 72 patients receiving MT (Group 2) were taken into further analysis. The co-morbidities were similar between the two groups, except for hyperlipidaemia. After a mean follow-up duration of 58.9 ± 42.6 months, Group 1 had a lower HF hospitalization and all-cause mortality compared with Group 2 (hazard ratio (HR), 0.089 [95% confidence interval (CI), 0.011-0.747]; P = 0.026 and HR, 0.121 [95% CI, 0.016-0.894]; P = 0.038, respectively). As for cardiac structural remodelling, the Group 1 had a better improvement in left ventricular ejection fraction (LVEF) and a more decreased left atrium (LA) diameter than Group 2 (+25.0% ± 18.0% vs. +6.2% ± 21.6%, P = <0.0001 and À1.6 ± 4.7 mm vs. +1.5 ± 8.2 mm, P = 0.008, respectively). Conclusions In patients with HFmrEF and AF, CA of AF could reduce both HF hospitalization and all-cause mortality as compared with those with MT. A significant improvement in LVEF and decrease in LA diameter were also observed in the CA group. Early rhythm control with CA should be taken into consideration in patients with HFmrEF and AF.

Effectiveness of Catheter Ablation in Left Ventricular Ejection Fraction, Stroke, Quality of Life, All-Cause Mortality, Sinus Rhythm Maintenance, and Hospitalization Rates as Compared to Medical Therapy

“…In patients undergoing CA, a reduction in the left atria (LA) diameter and a subsequent improvement in LVEF were observed in the study by Lee et al [ 22 ]. The mechanism of LA dysfunction changes based on the degree of HF.…”

“…In another trial, it was observed that SR maintenance was essential for preventing mortality [ 16 , 50 ]. The superiority of CA versus AADs has been demonstrated in the randomized AATAC trial, in which HFrEF patients with persistent AF receiving CA were significantly more likely to be free from AF recurrence (70% vs. 34%, P < 0.001) and have lower mortality rate (8% vs. 18%) than the patient receiving amiodarone [ 22 , 49 , 51 ].…”

“…Lee et al (2023) demonstrated the substantial benefit of CA in improving all-cause mortality and HF hospitalization rates in HF patients with paroxysmal or persistent AF. But in the AMICA trial, the same benefit was not observed in all patients with AF and HF [ 22 ]. The study also demonstrated that the benefit of CA is greater in patients with relatively better LVEF and less advanced HF stage [ 31 ].…”

“…al. all-cause mortality was reduced in all the subgroups irrespective of the degree of HF [ 22 ]. The meta-analysis conducted by Magnocavallo et al demonstrated similar findings that CA was associated with a 25% reduction in all-cause mortality and hospitalization compared to MT [ 10 ].…”

“…The ARC-HF and CAMERA-MRI trials demonstrate that rhythm control by CA is superior to rate control in improving quality of life, and LVEF improvement [ 22 ]. Although both AADs and CA led to burden reduction of AF, patients who underwent CA had better outcomes such as improved all-cause mortality and reduction in hospitalization [ 22 ].…”