Catheter ablation of atrial fibrillation in patients with heart failure: Insights from the NCDR atrial fibrillation ablation registry.

BACKGROUND

Catheter ablation (CA) for atrial fibrillation (AF) is a widely used treatment strategy in patients with and without heart failure (HF).

OBJECTIVE

To evaluate patient characteristics, ablation strategies, and complications of CA for AF by HF status.

METHODS

We conducted a retrospective analysis of patients undergoing CA between 2016 and 2022 from the National Cardiovascular Data Registry. Patients were grouped by: HF with reduced ejection fraction (HFrEF), HF with preserved EF (HFpEF), and no HF. Multivariable logistic regression was used to assess complication risk.

RESULTS

Among 75,527 patients, 51,285 had no HF, 13,625 had HFrEF, and 10,617 had HFpEF. HF groups had a higher prevalence of hypertension, diabetes, and coronary disease. Patients with HFrEF received more adjunctive ablation than patients HFpEF or no HF, including linear (32%, 29.3%, and 23.4%, respectively) and cavotricuspid isthmus ablation (33.1%, 30.2%, and 30.1%, respectively) (P < .0001). Complication rates were higher in HFrEF (4%) and HFpEF (3.8%) vs no HF (2%), with adjusted odds ratios (HFrEF: OR, 1.80; P < .0001; HFpEF: OR, 1.42; P < .0001). Complication rates declined from 2016 to 2022 across all groups (HFrEF: 5.2% to 2.9%, P = .0002; HFpEF: 5.9% to 3.0%, P < .0001; no HF: 2.8% to 1.6%, P < .0001). Ablation volume increased from 2018 to 2022 by 138% (HFrEF), 191% (HFpEF), and 113% (no HF).

CONCLUSION

Patients with HFrEF and HFpEF have more comorbidities, undergo more adjunctive ablation, and experience higher complication rates. Despite this, ablation volumes rose and complications declined across all groups over time.