Heart failure hospitalization from recurrent atrial fibrillation is uncommon after catheter ablation in patients with heart failure with reduced ejection fraction.

BACKGROUND

Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns that AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence after catheter ablation on heart failure is not well understood.

OBJECTIVE

We sought to examine the clinical outcomes and hospitalization patterns in patients with AF HFrEF after catheter ablation.

METHODS

This multicenter study reports the readmission outcomes for patients with AF and HFrEF (left ventricular ejection fraction [LVEF] ≤40%) after catheter ablation.

RESULTS

A total of 231 patients (60.5 ± 11.1 years, 37 female patients, mean LVEF 30.7% ± 7.1%, persistent AF 87.9%) with AF and HFrEF underwent catheter ablation. At 3-year follow-up, recurrent AF occurred in 120 (51.9%) and complete left ventricular systolic recovery (LVEF ≥50%) in 125 patients (54%). There were 366 hospitalizations among 123 patients: 240 cardiac and 126 noncardiac. Arrhythmia-related hospitalizations occurred in 179: 151 recurrent atrial arrhythmia without heart failure, 4 AF with heart failure, 3 supraventricular tachycardia, and 21 ventricular arrhythmia. Other cardiac hospitalizations (61) included heart failure without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3), and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery after ablation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11-12.55; P = .03), persistent AF vs paroxysmal AF recurrence (OR, 1.76; 95% CI, 1.21-27.72; P = .03), ischemic cardiomyopathy (OR, 3.62; 95% CI, 1.16-11.30; P = .02), and furosemide use (OR, 4.96; 95% CI, 1.55-15.91; P < .01) were associated with future heart failure hospitalization.

CONCLUSION

After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF and heart failure, but more commonly present with heart failure without AF or AF without heart failure.