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Comparative Study
. 2020 Mar;31(3):682-688.
doi: 10.1111/jce.14369. Epub 2020 Jan 31.

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

Akira Fukui  1 , Tomomi Tanino  1 , Takanori Yamaguchi  2 , Kei Hirota  1 , Shotaro Saito  1 , Norihiro Okada  1 , Hidefumi Akioka  1 , Tetsuji Shinohara  1 , Kunio Yufu  1 , Naohiko Takahashi  1
Affiliations
Comparative Study

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

Akira Fukui et al. J Cardiovasc Electrophysiol. 2020 Mar.

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.

Keywords: ablation; antiarrhythmic durgs; atrial fibrillation; heart failure with preserved ejection fraction; rehospitalization.

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REFERENCES

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