Po-01-190 atrial fibrillation ablation in patients with heart failure

Randomized clinical trials have proposed that catheter ablation can improve outcomes in atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). Nevertheless, the impact of catheter ablation in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) remains scarce. To evaluate the impact of catheter ablation on AF recurrence and patients reported outcomes based on HF etiology. All consecutive patients from a prospective registry with available data on follow up that underwent catheter ablation between 2013 and 2022 at a tertiary referral center were analyzed. Primary endpoint was AF recurrence based on medical records and patients reported outcomes (online or phone call survey). Patients were grouped into 4 groups according to their baseline HF status (No HF, HFrEF, HFmrEF, and HFpEF). Patients survey at baseline, 6 months, and at one year were used to calculate AF severity score (AFSS) as well as AF burden. AF burden was defined as the mean of AF duration score and AF frequency score. A total of 7020 patients were included (75% No HF, 10% HFrEF, 9% HFmrEF, and 5% HFpEF). Periprocedural complications were low (<1%) and were similar in all groups. At 3 years the cumulative incidence of AF recurrence was highest in HFpEF (53%) followed by HFmrEF (41%), HFrEF (41%), and was lowest in those without HF (34%; Figure). Multivariate logistic regression comparing HF etiologies with no HF confirmed these results (HFpEF: HR=1.47, 95% CI 1.21-1.78; HFmrEF: HR=1.23, 95% CI 1.04-1.45; and HFrEF: HR=1.17, 95% CI 1.01-1.37; p<0.05 in all comparisons). Models showed a significant interaction between HF etiology and AF type (Table 1). In all groups, catheter ablation resulted in improvement in their AFSS (mean at baseline→mean at one year; NO HF 12.2→6.1, HFrEF 13.4→6.8, HFmrEF 13.1→5.9, HFpEF 14.9→9.7; p<0.01 for all comparisons). Catheter ablation resulted in a significant reduction of the AF burden in all groups. At one year, the AF duration was minimal in all groups but was highest in HFpEF (baseline 8/10; at one year 1.5/10) followed by HFrEF (7.8/10 vs 1.1/10), HFmrEF (7.6/10 vs 0.6/10), and No HF (6.6/10 vs 0.5/10). HFpEF patients have the highest recurrence rate and the highest burden. Yet, among those with AF recurrence, catheter ablation resulted in a significant reduction of their AF symptoms and AF burden.Tabled 1Multivariate RegressionAll PatientsHR (95%CI)P ValueNo HFReferenceReferenceHFrEF1.17(1.00-1.37)0.045HFmrEF1.23(1.04-1.45)0.015HFpEF1.47(1.21-1.78)<0.001Paroxysmal OnlyParoxysmal OnlyParoxysmal OnlyNo HFReferenceReferenceHFrEF1.83(1.38-2.43)<0.001HFmrEF1.31(0.97-1.76)0.076HFpEF2.17(1.51-3.11)<0.001Persistent OnlyPersistent OnlyPersistent OnlyNo HFReferenceReferenceHFrEF1.01(0.84-1.22)0.89HFmrEF1.17(0.96-1.42)0.13HFpEF1.28(1.01-1.60)0.036 Open table in a new tab