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Meta-Analysis
. 2021 Mar;60(2):221-229.
doi: 10.1007/s10840-020-00727-9. Epub 2020 Apr 1.

Catheter ablation of atrial fibrillation in heart failure: clinical, prognostic, and echocardiographic outcome

Arianna Cirasa  1 , Carmelo La Greca  2 , Domenico Pecora  2 , Alberico Sorgato  2 , Umberto Simoncelli  2 , Marco Campana  2 , Claudio Cuccia  2
Affiliations
Meta-Analysis

Catheter ablation of atrial fibrillation in heart failure: clinical, prognostic, and echocardiographic outcome

Arianna Cirasa et al. J Interv Card Electrophysiol. 2021 Mar.

Abstract

Purpose: Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients is associated with a lower rate of cardiac events compared with medical therapy. This study deals with the clinical, echocardiographic, and prognostic outcomes in these patients. Prognostic scores, as MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) score, may help to predict the outcomes.

Methods: From a single center, 47 patients with AF, HF, and left ventricular ejection fraction (LVEF) < 50% underwent CA. The primary endpoints were NYHA functional class, LVEF, and MAGGIC score.

Results: The median age of patients was 59 years; 49% had paroxysmal AF. At 12 months, a significant improvement of NYHA class (median before II [interquartile range (IQR) II-III] vs median after I [IQR I-II]) and of LVEF (median before 44% [IQR 37-47] vs median after 55% [IQR49-57]) was observed (p value < 0.001). The MAGGIC 1-year and 3-year probability of death was estimated before (mean score 13 [IQR 11-17]) and at 12-month (mean score 11 [IQR 8-13]), showing a significant decrease in the probability of death (p value <0.001). At 12-month, a lower LVEF was associated with more HF hospitalizations (p value 0.035). Coronary artery disease (CAD) (HR 5, p value 0.035) and MAGGIC score (HR 1.2, p value 0.030) were predictors of HF hospitalization.

Conclusions: CA for AF in HF patients was associated with a significant improvement of NYHA functional class and LVEF and a higher life expectation. CAD history, LVEF < 40%, and MAGGIC score before ablation were predictors of HF hospitalization.

Keywords: Atrial fibrillation; Catheter ablation; Heart failure; MAGGIC score.

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