Impact of the Temporal Relationship Between Atrial Fibrillation and Heart Failure on Prognosis After Ablation

• Published in: Circulation Journal Vol. 84; no. 9; pp. 1467 - 1474
• Main Authors: Tsuji, Aki, Masuda, Masaharu, Asai, Mitsutoshi, Iida, Osamu, Okamoto, Shin, Ishihara, Takayuki, Nanto, Kiyonori, Kanda, Takashi, Tsujimura, Takuya, Matsuda, Yasuhiro, Okuno, Shota, Hata, Yosuke, Mano, Toshiaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25-08-2020
• Subjects: Ablation; Aged; Aged, 80 and over; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Atrial Function, Left; Catheter Ablation - methods; Female; Follow-Up Studies; Heart failure; Heart Failure - complications; Heart Failure - mortality; Heart Failure - surgery; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Factors; Stroke Volume; Temporal relationship; Treatment Outcome; Heart failure; Temporal relationship; Prognosis; Ablation; Atrial fibrillation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-0191

Background:The purpose of this study was to elucidate the effect of the temporal relationship between atrial fibrillation (AF) and heart failure (HF) on clinical outcomes after catheter ablation.Methods and Results:We included 129 consecutive patients with AF and HF who underwent catheter ablation in hospital from December 2014 to September 2017. The patients were divided into 2 groups based on the temporal relationship between AF and HF. Group 1 consisted of 42 patients with AF following HF while Group 2 consisted of 87 patients with AF preceding HF or those who developed both of them simultaneously at the timing of first visit to a doctor. The primary endpoint was a composite of death and hospitalization due to HF during a 2-year follow-up. AF recurrence was more common in Group 1 (45% vs. 23%; hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.25–4.94; P=0.009). Death and HF hospitalization were more frequent in Group 1 (19 [45%], 6 [7%] patients, respectively, P<0.0001). After adjustment for several covariates, patients in Group 1 were independently associated with poorer outcomes after AF ablation (HR, 8.66; 95% CI, 2.942–5.5; P<0.0001).Conclusions:Adverse clinical outcomes of death, HF hospitalization and AF recurrence were more frequent in patients with AF following HF than in those with AF preceding HF.