Long-Term Outcomes of Catheter Ablation in Heart Failure With Reduced Ejection Fraction Patients With Atrial Fibrillation Journal Article
| Authors: | Nor, M.; Bolaji, O.; Bilal, A.; Mahmoud, M. S.; Wardhere, A.; Kelley, J.; Assal, C. |
| Article Title: | Long-Term Outcomes of Catheter Ablation in Heart Failure With Reduced Ejection Fraction Patients With Atrial Fibrillation |
| Abstract: | Background: While catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF), its impact on long-term clinical outcomes in patients with concomitant heart failure with reduced ejection fraction (HFrEF) remains uncertain. Objective: This study aimed to evaluate the clinical outcomes of CA versus conventional therapy in patients with HFrEF and AF. Methods: We utilized data from the TriNetX US Collaborative Network (January 2014-December 2024) with a 3-year follow-up period. Patients aged >= 18 years with HFrEF (EF < 40%) and AF were categorized into two cohorts: those received CA versus conventional therapy. Propensity score matching was performed to minimize selection bias. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization, recurrent AF, and heart failure (HF) hospitalization. Results: After propensity score matching, 64,743 patients remained in each cohort. The mean age was 73.4 +/- 11.4 years in the CA cohort and 73.5 +/- 11.5 years in the control cohort (p = 0.109). CA was associated with reduced all-cause mortality (HR = 0.46, 95% CI: 0.43-0.49, p < 0.001), all-cause hospitalization (HR = 0.94, 95% CI: 0.92-0.95, p < 0.001) and recurrent AF (HR = 0.80, 95% CI: 0.79-0.82, p < 0.001) but higher HF hospitalization (HR = 1.07, 95% CI: 1.06-1.08, p < 0.001) compared to conventional therapy. Conclusions: Our study demonstrated that in patients with AF and HFrEF, CA was associated with significantly reduced all-cause mortality, all-cause hospitalization, and AF recurrence, but an increased risk of HF hospitalization compared to conventional therapy. These findings suggest that CA may provide substantial long-term benefits in this high-risk population, while highlighting the importance of careful patient selection and post-procedural management. |
| Keywords: | mortality; atrial fibrillation; management; catheter ablation; trial; statement; propensity score matching; heart failure with reduced ejection fraction; all cause hospitalization |
| Journal Title: | PACE - Pacing and Clinical Electrophysiology |
| ISSN: | 0147-8389 |
| Publisher: | Wiley-Blackwell Publishing, Inc. |
| Publication status: | Online ahead of print |
| Date Published: | 2025-01-01 |
| Online Publication Date: | 2025-01-01 |
| Language: | English |
| ACCESSION: | WOS:001547145000001 |
| DOI: | 10.1111/pace.70017 |
| PROVIDER: | wos |
| Notes: | Article; Early Access -- Source: Wos |
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