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Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry
Karolinska Univ Hosp, Sweden.
Karolinska Inst, Sweden.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
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2022 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 24, no 9, p. 1636-1646Article in journal (Refereed) Published
Abstract [en]

Aims To investigate the association between catheter ablation for atrial fibrillation (AF) and mortality as well as hospitalization for heart failure (HF) in patients with HF across the ejection fraction (EF) spectrum. Methods and results Patients with first-time catheter ablation for AF (ablation group) compared to only medical treated AF patients (no ablation group) were identified from the Swedish Heart Failure Registry between 2005 and 2019. The primary outcome (all-cause mortality/first HF hospitalization) was assessed by Cox regression models in a 1:2 propensity score (PS) matched cohort and pre-specified EF subgroups (preserved EF [>= 50%], mildly reduced EF [40-49%], reduced EF [<40%]) of this cohort. A total of 452 patients in the ablation group and 43 766 patients in the no ablation group were identified. After PS matching, 434 patients in the ablation group were compared to 868 patients in the no ablation group. Over a median follow-up of 2.6 years (0.0-14.1 years), catheter ablation was associated with a lower risk of the primary outcome (all-cause mortality/first HF hospitalization) (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.65-0.94). Results were consistent across all EF subgroups. In HF with preserved EF (HFpEF), catheter ablation was also associated with a lower risk of recurrent HF hospitalization (incidence rate ratio 0.17, 95% CI 0.07-0.42). Conclusion In HF patients across the EF spectrum, catheter ablation for AF was associated with lower risk of the primary outcome (all-cause mortality/first HF hospitalization). This study supports catheter ablation as a treatment option for AF in HF patients, including those with HFpEF.

Place, publisher, year, edition, pages
WILEY , 2022. Vol. 24, no 9, p. 1636-1646
Keywords [en]
Atrial fibrillation; Catheter ablation; Registry; Heart failure with preserved ejection fraction; Heart failure with mildly reduced ejection fraction; Heart failure with reduced ejection fraction
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-187361DOI: 10.1002/ejhf.2604ISI: 000828254100001PubMedID: 35779270OAI: oai:DiVA.org:liu-187361DiVA, id: diva2:1688795
Note

Funding Agencies| [OL 605/1-1]

Available from: 2022-08-19 Created: 2022-08-19 Last updated: 2023-02-03

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Dahlström, Ulf
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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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