Early or Delayed AF Ablation After HF Hospitalization?

TOPLINE:

Among patients with atrial fibrillation (AF) hospitalized for worsening heart failure (HF), catheter (cath) ablation within 90 days of admission compared with other times is associated with reduced risk for all-cause mortality and HF-related mortality.

METHODOLOGY:

Cath ablation has become technically safer for patients with both AF and HF, but the best timing for the ablation procedure after HF hospitalization has been unclear.

The study included 2786 patients with HF who underwent cath ablation for AF at 128 centers in the nationwide Japanese Registry of Acute Decompensated Heart Failure, were hospitalized with worsening HF, and survived at least 90 days after discharge.

They population included 103 individuals who underwent cath ablation within 90 days after admission; the remaining 2683 participants served as the control group.

The researchers also looked at all-cause mortality 90 days after admission for HF in analysis of 83 early-ablation cases vs 83 propensity-matched controls.

TAKEAWAY:

The early–cath ablation group was younger, predominantly male, had lesser history of prior HF hospitalizations, and greater incidence of paroxysmal AF compared with the control group.

All-cause mortality was significantly lower in the early–cath ablation group than in the control group (hazard ratio [HR], 0.38; 95% CI, 0.24-0.60; P <.001) over a median of 4.1 years.

Risk reductions were similarly significant for secondary endpoints, including cardiovascular (CV) mortality and HF mortality.

In the matched cohort analysis (83 in both groups) all-cause mortality was significantly reduced for those in the early–cath ablation group compared with the matched controls (HR 0.47; 95% CI, 0.25-0.88; P = .014), with similarly significant risk reductions for CV mortality and HF mortality.

IN PRACTICE:

"Early catheter ablation may prevent AF recurrence and subsequent HF exacerbation or fatal arrhythmia in patients hospitalized for HF," the report states. Early catheter ablation, as early as during the hospitalization for HF, "might be a way to stabilize HF and solve the problems associated with long hospitalization periods and polypharmacy."

SOURCE:

The study was conducted by Kazuo Sakamoto, MD, PhD, Kyushu University, Fukuoka, Japan, and colleagues. It was published online July 19, 2023 in JACC: Clinical Electrophysiology

LIMITATIONS:

The early-ablation cohort was much smaller than was the control group, and the analysis could not adjust for any variation in institutional characteristics, such as location and available equipment. Other unmeasured potential confounders include duration of AF and patient lifestyle characteristics and success or failure of ablation.

DISCLOSURES:

The study was funded by Johnson & Johnson, the Japan Agency for Medical Research and Development, and Ministry of Health and Labor. Sakamoto reports no relevant conflicts; disclosures for the other authors are in the report.

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Early or Delayed AF Ablation After Heart Failure Hospitalization?