Key result
Catheter ablation is linked to fewer major events vs non-ablation in ADHF and AF.
Why the study?
Prognosis in acute decompensated heart failure and heart failure with atrial fibrillation has been dismal, prompting investigation of catheter ablation outcomes in patients with concurrent ADHF and AF.
Does catheter ablation improve event-free survival in patients with concurrent acute decompensated heart failure and atrial fibrillation?
Cohort (n=472)
No
Does catheter ablation improve event-free survival in patients with concurrent acute decompensated heart failure and atrial fibrillation?
p-value: p=<0.001
Catheter ablation is associated with improved event-free survival from cardiovascular death and heart failure hospitalization in patients presenting with concurrent acute decompensated heart failure and atrial fibrillation.
Should not yet change practice in ADHF-AF; hypothesis-generating and requires randomized confirmation.
Background: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. Methods: We retrospectively analyzed ADHF patients with AF who were admitted to our institution from 2007 to 2017. Results: In total, 472 patients were included in this study, with a mean follow-up duration of 32.8 ± 32.9 months. The 5-year event-free rate (cardiovascular death and HF hospitalization) was 61.4%, and the 10-year event-free rate was 42.7%. A comparative analysis of the event group and control group revealed that patients in the event group were older (event group vs. control group: 72.1 ± 11.0 vs. 68.8 ± 13.4 years, p = 0.008) and had a higher proportion of Clinical Scenario 3 classifications (event group vs. control group: 24% vs. 12%, p = 0.001). Notably, patients in the event group had a lower sinus rhythm maintenance rate (event group vs. control group: 17% vs. 31%, p < 0.001) and CA rate (event group vs. control group: 9% vs. 21%, p = 0.003). The CA group had a higher event-free rate than the non-CA group, and this trend persisted even after matching the patients’ backgrounds (log-rank test: p < 0.001). Conclusions: Patients presenting with AF at the onset of ADHF showed a poor prognosis, whereas CA demonstrated potential for improving the prognosis for some of these patients.
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Ikeda et al. (2025) conducted a cohort in Acute decompensated heart failure with atrial fibrillation (n=472). Catheter ablation vs. Non-catheter ablation was evaluated on Cardiovascular death and HF hospitalization (p=<0.001). Catheter ablation was associated with higher event-free survival from cardiovascular death and HF hospitalization compared to non-ablation in patients with ADHF and AF (p<0.001).
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