Aim:

Catheter ablation of atrial fibrillation (AF) is a safe and effective treatment option to restore and maintain sinus rhythm. Patients with different stages of heart failure (HF) appear to have specific clinical benefit from catheter ablation. We aim to elucidate the acute and procedural outcomes of HF patients undergoing AF ablation.

Methods:

In this study 1092 consecutive AF patients with (n=558) and without heart failure undergoing PVI in a single high-volume center were retrospectively analyzed. We compared baseline parameters, procedural parameters, and acute outcome.

Results:

We identified 1092 patients with AF who underwent PVI (32.6% female, 64.9 ± 10.8 years, 40.6% paroxysmal AF). Of these, 166 (15.2%) patients had HF with reduced ejection fraction (HFrEF), 141 (12.9%) HF with mildly reduced ejection fraction (HFmrEF), 251 (23%) HF with preserved ejection (HFpEF) and 534 (48.9%) were without HF. Patients with HFpEF were older (68.9 ± 9 (HFpEF) vs. 63.6 ± 10.8 (HFrEF) vs. 65.5 ± 10.1 (HFmrEF) vs. 63.3 ± 11.4 years (without HF); p < 0.05) and more often female (48.2% (HFpEF) vs. 22.9% (HFrEF) vs. 17.7% (HFmrEF) vs. 32.2% (without HF); p < 0.05). While patients with HFpEF had more cardiovascular risk factors than patients without HF (hypertension: 71.7% vs. 59.7%, p < 0.05; type 2 diabetes: 16.7% vs. 9.4%, p < 0.05; dyslipidemia: 41.4% vs. 27.2%, p < 0.05), there was no difference in patients with HFrEF or HFmrEF. Persistant AF was more common in patients with HFrEF and HfmrEF (81.3% (HfrEF) vs. 81.6% (HfmrEF) vs. 55.4% (HfpEF) vs. 47% (without HF); p < 0.05). Comparing echocardiographic findings before PVI, patients with HF had larger left atrial volumes (98.6 ± 39.6 ml (HFrEF) vs. 83.2 ± 26 ml (HFmrEF), vs. 72.9 ± 23.3 ml (HFpEF) vs. 66.9 ± 21.8 ml (without HF); p < 0.05). Cryoballoon ablation was performed more frequently in patients with HFpEF and without HF (37.8% (HFpEF) vs. 41.6% (without HF) vs. 28.4% (HFmrEF) vs. 25.3% (HFrEF); p < 0.05). Acute PVI was achieved in all patients. Periprocedural complications were numerically less frequent in patients with HFrEF, but there was a trend towards a higher incidence of more severe complications. Patients with HF had longer length of hospital stay (mean days 3.7 ± 0.3 (HFrEF) vs. 2.9 ± 0.2 (HFmrEF) vs. 2.7 ± 0.2 (HFpEF) vs. 2.4 ± 0.1 days (without HF); p < 0.05).

Conclusion:

This study provides a comprehensive comparison of AF patients who underwent PVI, categorized by their HF status. It highlights variations in demographic characteristics, presence of risk factors, and procedural outcomes across these patient groups. This information may aid in tailoring more specific treatment strategies for AF patients, depending on their HF status.