Reduction of mortality by catheter ablation in real-world atrial fibrillation patients with heart failure

Abstract

Whether catheter ablation for atrial fibrillation (AF) improves survival and affects other outcomes in real-world heart failure (HF) patients is unclear. This study aimed to evaluate whether ablation reduces death, and other outcomes in real-world AF patients with HF. Among 834,735 patients with AF from 2006 to 2015 in the Korean National Health Insurance Service database, 3173 HF patients underwent AF ablation. Propensity score weighting was used to correct for differences between the groups. During median 54 months follow-up, the risk of all-cause death in ablated patients was less than half of that in patients with medical therapy (2.8 vs. 6.2 per 100 person-years; hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.27-0.65, p < 0.001). Ablation was related with lower risk of cardiovascular death (HR 0.38, 95% CI 0.32-0.62, p < 0.001), HF admission (HR 0.39, 95% CI 0.33-0.46, p < 0.001) and stroke/systemic embolism (HR 0.44, 95% CI 0.37-0.53, p < 0.001). In subgroup analysis, the risk of all-cause death was reduced in most subgroups except in the elderly (≥ 75 years) and strictly anticoagulated patients. Ablation may be associated with reduced risk of all-cause death and cardiovascular death in real-world AF patients with HF, supporting the role of AF ablation in patients with HF.

Figure 1

Flowchart of the enrollment and analysis of the study population. AF, atrial fibrillation; ICD, implantable cardioverter-defibrillator; OAC, oral anticoagulant.

Figure 2

Weighted cumulative incidence curves of (A) all-cause death and (B) cardiovascular death for ablated and medical therapy patients. Figure prepared in R software (version 3.6.1, R Core Team, 2019, Vienna, Austria).

Figure 3

Subgroup analyses of the risk of all-cause death. HR: hazard ratio, TIA: transient ischemic attack, OAC: oral anticoagulant.

Figure 4

Subgroup analyses of the risk of cardiovascular death. HR, hazard ratio, TIA, transient ischemic attack, OAC, oral anticoagulant.

Figure 5

Weighted cumulative incidence curves of (A) heart failure, (B) ischemic stroke/SE, and (C) sudden cardiac death for patients with ablation or medical therapy. SE, systemic embolism. Figure prepared in R software (version 3.6.1, R Core Team, 2019, Vienna, Austria).