Key result
Early catheter ablation for heart failure linked to ~53% lower all-cause mortality vs no early ablation.
Why the study?
Catheter ablation improves prognosis in heart failure and AF, but the optimal timing of ablation remains to be fully elucidated.
Does early catheter ablation for atrial fibrillation reduce all-cause mortality in patients hospitalized for worsening heart failure?
Cohort (n=2,786)
Yes
Does early catheter ablation for atrial fibrillation reduce all-cause mortality in patients hospitalized for worsening heart failure?
Effect estimate: HR 0.47 (95% CI 0.25-0.88)
p-value: p=0.014
Early catheter ablation for atrial fibrillation within 90 days of admission for worsening heart failure is associated with significantly reduced all-cause, cardiovascular, and heart failure mortality.
Hypothesis-generating for early ablation in HF with AF; randomized trials needed before practice change.
BACKGROUND: Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of patients with heart failure (HF) and AF. However, its optimal timing remains to be fully elucidated. OBJECTIVES: The aim of this study was to investigate the prognostic impact of early CA in patients with HF and AF hospitalized for worsening HF. METHODS: From JROADHF (Japanese Registry of Acute Decompensated Heart Failure) (n = 13,238), patients with HF and AF who underwent CA within 90 days after admission for HF (early CA; n = 103) and those who did not (control; n = 2,683) were identified. Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n = 83 in each group). RESULTS: In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray' test: P < 0.001 and P = 0.005; subdistribution HR: 0.28 [95% CI: 0.13-0.63] and HR: 0.31 [95% CI: 0.13-0.75]; matched: Gray's test: P = 0.006 and P = 0.017; subdistribution HR: 0.24 [95% CI: 0.08-0.70] and HR: 0.28 [95% CI: 0.09-0.84], respectively). CONCLUSIONS: In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in patients with HF and AF.
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Sakamoto et al. (2023) conducted a cohort in Heart failure and atrial fibrillation (n=2,786). Early catheter ablation (within 90 days after admission) vs. No early catheter ablation was evaluated on All-cause mortality (HR 0.47, 95% CI 0.25-0.88, p=0.014). Early catheter ablation within 90 days of admission for heart failure was associated with lower all-cause mortality compared to no early ablation (HR 0.47; 95% CI 0.25-0.88; P=0.014).