Early catheter ablation for AF after HF hospitalistation may improve long-term outcomes

Early catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure (HF) has shown promising results in improving long-term outcomes, according to a new study published in JACC Clinical Electrophysiology by Kazuo Sakamoto and colleagues based on data from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF). The study investigated the impact of early CA, performed within 90 days after admission for worsening HF, on patient prognosis.

Researchers identified 103 patients who underwent early CA and compared them to a control group of 2,683 patients with HF and AF who did not undergo CA within the same timeframe.

● The study found that in the crude cohort, all-cause mortality was significantly lower in the early CA group compared to the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60).

● After conducting a propensity-matched analysis, which included 83 patients in each group, the results remained consistent, with all-cause mortality being significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88).

● The study showed that cardiovascular death and HF mortality were significantly lower in both cohorts.

● In the crude cohort, cardiovascular death (Gray's test: P < 0.001) and HF mortality (Gray's test: P = 0.005) were markedly reduced, with subdistribution HRs of 0.28 (95% CI: 0.13-0.63) and 0.31 (95% CI: 0.13-0.75), respectively.

● In the matched cohort, cardiovascular death (Gray's test: P = 0.006) and HF mortality (Gray's test: P = 0.017) were significantly lower, with subdistribution HRs of 0.24 (95% CI: 0.08-0.70) and 0.28 (95% CI: 0.09-0.84), respectively.

These findings suggest that early CA for AF in patients with HF can lead to improved long-term outcomes, reducing the risk of cardiovascular and HF-related deaths. The study provides valuable insights into the potential benefits of early CA in this patient population, paving the way for further research and optimized treatment strategies for HF patients with AF.

Reference:

Sakamoto, K., Tohyama, T., Ide, T., Mukai, Y., Enzan, N., Nagata, T., Ikeda, M., Takase, S., Nagayama, T., Fujino, T., Matsushima, S., & Tsutsui, H. (2023). Efficacy of early catheter ablation for atrial fibrillation after admission for heart failure. JACC. Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2023.05.038