Abstract 13414: 5-year Impact of Catheter Ablation for Atrial Fibrillation on Cardiac Function and Heart Failure in Patients With Baseline Moderate-severe Systolic Heart Failure
Backgroud. Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach. 1-year outcomes of ablation in patients with systolic heart failure (SHF) have shown that ejection fraction(EF), and risk of heart failure progression and death are improved. However, SHF is often a progressive process and as such, long-term data regarding cardiac function and heart failure are needed.
Methods: 3 groups with SHF and 5 years of follow-up were matched 1:4:4 by age(±5 years) and sex. AF ablation patients receiving their first ablation (n=267), AF patients that did not receive an ablation (n=1068), and SHF patient without AF (n=1068). A patient was deemed as having SHF if they had both a clinical diagnosis(ICD-9 code 428.8*) and an EF<35%. Patients were followed for 5-year outcomes of HF and cardiac function.
Results: The average age of the population was 67±13 years and 78% male. The AF was paroxysmal in 25%, persistent in 34.7%, and longstanding persistent in 41%. Serial echocardiogram data were available on a subset of the population, although these were not performed per a routine protocol (AF ablation: 87, AF no ablation: 292, no AF: 213, p=0.17). Cardiac function in the AF ablation group improved the most at 3 years, then all groups were largely similar at 5 years and the composite of the last study ordered within our network (p=0.17). Worsening of an EF compared to an improvement after ablation trended towards an increased risk of AF recurrence (HR 1.65: 95% CI: 0.47-5.83, p=0.33). The AF Ablation and No AF groups had the lowest long-term HF hospitalization rates (14%, 15%, vs. 21%, p<0.0001).
Conclusion: Early improvements in cardiac function in patients with SHF are observed after catheter ablation, but on average are not maintained at 5 years. Despite similarities in EF, long-term heart failure was lower in the AF ablation and no AF groups, a finding that likely reflects maintenance of atrial systolic function and less exposure to antiarrhythmic drugs.
Author Disclosures: T.J. Bunch: None. H.T. May: None. T.L. Bair: None. V. Jacobs: None. B.G. Crandall: None. M. Cutler: None. J.P. Weiss: None. C. Mallendar: None. J.S. Osborn: None. J.L. Anderson: None. J.D. Day: None.
- © 2014 by American Heart Association, Inc.