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. 2020 Nov 23;37(1):60-69.
doi: 10.1002/joa3.12451. eCollection 2021 Feb.

Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction

Rajkumar Doshi  1 , Ashish Kumar  2 , Mariam Shariff  2 , Devina Adalja  3 , Krunalkumar Patel  4 , Kirtenkumar Patel  5 , Rupak Desai  6 , Nageshwara Gullapalli  1 , Saraschandra Vallabhajosyula  7
Affiliations

Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction

Rajkumar Doshi et al. J Arrhythm. .

Abstract

Background: There is a lack of research comparing procedural outcomes of surgical ablation (SA) and catheter ablation (CA) among patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The main objective was to compare the short-term procedural outcomes of SA and CA in patients with HFrEF.

Methods: We used the national inpatient sample to identify hospitalizations over 18 years with HFrEF hospitalization and AF, and undergoing SA and CA from 2016 to 2017. Furthermore, the clinical outcomes of SA vs CA in AF stratified as nonparoxysmal and paroxysmal were analyzed.

Results: A total of 1,770 HFrEF hospitalizations with AF who underwent SA and 1,620 HFrEF hospitalizations with AF who underwent CA were included in the analysis. Hospitalizations with CA had higher baseline comorbidities. The in-hospital mortality among HFrEF with AF undergoing SA as compared with CA was similar (2.8% vs 1.9%, respectively, adjusted P-value 0.09). Hospitalizations with SA had a significantly longer length of hospital stay, a higher percentage of postprocedural, and cardiac complications. In HFrEF hospitalizations with nonparoxysmal AF, SA as compared with CA was associated with a higher percentage of in-hospital mortality (2.4% vs 1%, adjusted P-value <.05), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications.

Conclusion: CA is associated with lower in-hospital adverse procedural outcomes as compared with SA among HFrEF hospitalizations with AF. Further research with freedom from AF as one of the outcome is needed between two groups for HFrEF.

Keywords: HFrEF; atrial fibrillation; catheter ablation; surgical ablation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart for the selection of the hospitalizations
FIGURE 2
FIGURE 2
Differences in the clinical outcomes forhospitalizations with atrial fibrillation and heart failure with reduced ejection fraction: Stratified by gender and type of the procedure
FIGURE 3
FIGURE 3
Differences in the clinical outcomes forhospitalizations with atrial fibrillation and heart failure with reduced ejection fraction: Stratified by race and type of the procedure
See this image and copyright information in PMC

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