Key result
Catheter ablation linked to ~58% lower mortality vs. medical therapy in AF patients with HF.
Why the study?
Whether catheter ablation for AF improves survival and affects other clinical outcomes in real-world patients with HF remains unclear.
Does catheter ablation reduce all-cause death in real-world atrial fibrillation patients with heart failure?
Cohort (n=15,231)
Does catheter ablation reduce all-cause death in real-world atrial fibrillation patients with heart failure?
Hazard Ratio: 0.42 (95% CI 0.27–0.65)
Absolute Event Rate: 2.8% vs 6.2%
p-value: p=<0.001
In a real-world cohort of patients with atrial fibrillation and heart failure, catheter ablation was associated with a significant reduction in all-cause mortality, cardiovascular mortality, heart failure admissions, and stroke compared to medical therapy.
Ablation was associated with lower mortality in real-world AF-HF patients; leaves open confirmation via randomized trials before changing practice.
Whether catheter ablation for atrial fibrillation (AF) improves survival and affects other outcomes in real-world heart failure (HF) patients is unclear. This study aimed to evaluate whether ablation reduces death, and other outcomes in real-world AF patients with HF. Among 834,735 patients with AF from 2006 to 2015 in the Korean National Health Insurance Service database, 3173 HF patients underwent AF ablation. Propensity score weighting was used to correct for differences between the groups. During median 54 months follow-up, the risk of all-cause death in ablated patients was less than half of that in patients with medical therapy (2.8 vs. 6.2 per 100 person-years; hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.27-0.65, p < 0.001). Ablation was related with lower risk of cardiovascular death (HR 0.38, 95% CI 0.32-0.62, p < 0.001), HF admission (HR 0.39, 95% CI 0.33-0.46, p < 0.001) and stroke/systemic embolism (HR 0.44, 95% CI 0.37-0.53, p < 0.001). In subgroup analysis, the risk of all-cause death was reduced in most subgroups except in the elderly (≥ 75 years) and strictly anticoagulated patients. Ablation may be associated with reduced risk of all-cause death and cardiovascular death in real-world AF patients with HF, supporting the role of AF ablation in patients with HF.
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Yang et al. (2021) conducted a cohort in Atrial fibrillation with heart failure (n=15,231). Catheter ablation vs. Medical therapy (antiarrhythmic drugs or rate control drugs) was evaluated on All-cause death (HR 0.42, 95% CI 0.27-0.65, p=<0.001). Catheter ablation was associated with a 58% lower risk of all-cause death compared to medical therapy in real-world atrial fibrillation patients with heart failure.
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