INTRODUCTION
Catheter ablation for atrial fibrillation (AF) has been shown to reduce mortality and heart failure (HF) progression in patients with AF and HF with reduced ejection fraction; however, outcomes in HF with preserved ejection fraction (HFpEF), especially the optimal timing of ablation, remain uncertain.
OBJECTIVES
To evaluate long-term outcomes of catheter ablation in patients with AF and HFpEF based on the temporal correlation between the AF diagnosis and the ablation procedure utilizing real-world data.
METHODS
In this observational cohort study using the U.S. Collaborative Network in TriNetX, adults with AF and HFpEF between October 2018 and October 2024 were identified. After 1:1 propensity score matching, 5550 patients were included. The primary endpoint was a composite of cardioversion, new antiarrhythmic drug (AAD) therapy, or repeat AF ablation after a 3-month blanking period. Secondary endpoints included hospitalization, mortality, HF exacerbation, and AAD use up to 4 years of follow-up. Outcomes were compared between patients undergoing ablation within 1 year of AF diagnosis and those having ablation after 1 year.
RESULTS
Over a mean follow-up of 742 ± 489 days, early AF ablation was associated with lower risks of the primary endpoint (hazard ratio (HR) 0.81, 95% CI 0.76-0.87, p < 0.001), reduced hospitalization (HR 0.77, 95% CI 0.70-0.87, p < 0.001), and lower AAD Class I or III use (HR 0.82, 95% CI 0.77-0.88, p < 0.001). No significant differences were observed in HF exacerbations (HR 0.99, 95% CI 0.89-1.00, p = 0.950) or mortality (HR 1.18, 95% CI 0.91-1.53, p = 0.211).
CONCLUSION
Early catheter ablation was associated with a decreased all-cause hospitalization and AF recurrence in HFpEF patients but did not reduce HF exacerbations or mortality.
M. Moersdorf, M. Abou-Khalil, C. El Khoury et al.· Clinical Research in Cardiol...· 0 citations
BACKGROUND
In patients with structural heart disease (SHD) and moderately impaired left ventricular ejection fraction (LVEF > 35%), data on outcomes after ventricular tachycardia (VT) ablation remain limited. This analysis focuses on VT recurrence after ablation in patients presenting with sustained VT and LVEF > 35% within a secondary-prevention population.
OBJECTIVE
To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF > 35%.
METHODS
We analyzed 219 consecutive patients with SHD and LVEF > 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups.
RESULTS
ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial-epicardial ablation was required in 28% of NICM patients (p < 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; p < 0.001). Procedural complications were infrequent and comparable between groups (6% overall; p = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; p = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3-4.0, p = 0.004), while acute non-inducibility was associated with a lower recurrence risk.
CONCLUSION
VT ablation in SHD patients with LVEF > 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.
Said-Elias Waezsasa, M. Khalaph, M. Braun et al.· Cardiovascular Electrophysio...· 0 citations
BACKGROUND
The prognostic relevance of implantable cardioverter defibrillator (ICD) in patients with end-stage heart failure (HF) with left ventricular assist device (LVAD) remains controversial.
OBJECTIVES
To evaluate the prognostic impact of ongoing use of ICD and associated complications in HF-patients with LVAD-implantation.
METHODS
We retrospectively analyzed all consecutive patients (n = 351) who underwent LVAD-implantation and follow up between 2009 and 2021. Patients were categorized according to the presence (n = 254) or absence (n = 97) of ICD. To reduce baseline imbalances between groups, propensity score matching (PSM) was performed, yielding two matched cohorts of 79 patients each. The primary endpoint was a composite of all-cause mortality and heart transplantation. Secondary endpoints included all-cause mortality, heart transplantation, and ICD-related complications.
RESULTS
Median age was 58 [49-65] years, and 85% were male. Median follow-up duration was 3.6 [2.6-5.7] years. The primary endpoint revealed significantly less events in the ICD cohort (44.3% vs. 59.5% (HR 0.6 95%CI [0.40; 0.97], p = 0.035)). The difference was driven by a higher rate of all-cause mortality (22.08% vs. 41.8%, p = 0.008), while the heart transplantation rate was similar (17.7% vs. 21.5%, p = 0.98). ICD-related complications occurred in 20.4% of all ICD-patients, including 27 lead revisions, 8 complete system removals due to infection, 13 inadequate shocks and 4 hematoma evacuations.
CONCLUSION
ICD therapy was associated with lower mortality in this single-center LVAD-cohort. However, this finding contrasts with recent meta-analytic. Given the substantial burden of ICD-related complications, ICD-management after LVAD-implantation should be individualized according to arrhythmic risk, pacing requirements, procedural risk, and patient preferences.
N. Baridwan, Mustafa Gerçek, M. Gerçek et al.· Pacing and clinical electrop...· 0 citations
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