Abstract 19631: Incidence and Correlates of Symptomatic Heart Failure After Pulmonary Vein Isolation
Introduction: The incidence and correlates of new-onset symptomatic heart failure (HF) after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are unclear.
Methods: We prospectively enrolled consecutive AF pts presenting for radiofrequency PVI between November 2013-June 2014. Pts with recent HF hospitalization or symptomatic HF on the day of PVI were excluded. Post-discharge symptoms were assessed via telephone follow-up in all pts and clinic visits when appropriate. Primary outcome was development of new symptomatic HF requiring treatment with new/increased diuretic dosing. Secondary outcomes were prolonged index hospitalization and readmission for HF ≤ 30d. Univariate and multivariable logistic regression were used to assess relationships between pt and procedural characteristics and post-PVI HF.
Results: Among 113 pts (median age 62.1 yrs, 89.0% male, 22.7% non-paroxsymal AF, median LVEF 55%), 30 pts (26.5%) developed new symptomatic HF. Symptoms occurred within 2 days in 80% of pts. 7 pts (6.2%) required prolonged index hospitalization for HF and 9 pts (8.0%) were readmitted for HF within 30d. In univariate analyses, non-paroxsymal AF (OR 2.9, p=0.029), AF at start of PVI (OR 3.2, p=0.008), performing additional ablation lines (OR 7.7, p<0.001), and ending left atrial pressure (LAP) (OR 1.1 per 1 mmHg increase, p=0.02) correlated with development of symptomatic HF. Age, gender, prior PVI, prior HF, diabetes, hypertension, LA diameter, net fluid status, and LVEF were not associated with HF. In multivariable analyses adjusting for age, AF at start of PVI, LVEF, additional ablation lines, ending LAP, and net fluid intake, only additional ablation lines (ORadj 6.87, p=0.003) were independently associated with development of HF.
Conclusions: 26.5% of pts undergoing PVI for AF develop symptomatic HF when prospectively and uniformly assessed. 14.2% of pts experience prolonged index hospitalizations or readmission for management of HF within 30d. Performing additional ablation lines is independently and strongly associated with post-PVI HF suggesting a mechanical or humoral link between ablation of atrial tissue and subsequent HF. Improved understanding of risk factors may be critical in developing strategies to address post-PVI HF.
- Atrial fibrillation
- Arrhythmias, treatment of
- Heart failure
- Acute heart failure
- Ablation, radiofrequency
Author Disclosures: H.D. Huang: None. J.W. Waks: None. F. Contreras: None. M.E. Josephson: None.
- © 2014 by American Heart Association, Inc.