How treating AFib with catheter ablation affects patients with heart failure

Using catheter ablation to treat atrial fibrillation (AFib) in patients with heart failure does not reduce mortality, according to new findings published in the American Journal of Cardiology.

Such a strategy, however, may lead to other benefits worthy of additional research.

“AFib is reaching epidemic proportions with a global disease burden estimated at 33 million individuals,” wrote lead author Shilpkumar Arora, MD, MPH, Case Western Reserve University in Cleveland, Ohio, and colleagues. “AFib has been associated with heart failure syndromes, and the optimal management and impact of one on each other continues to be a clinical challenge and scientific curiosity. Medical management aimed at controlling the rate or maintenance of sinus rhythm has been the cornerstone of the management approach for decades. These therapies have demonstrated inconsistent results while carrying a significant risk of adverse effects, especially with long-term use.”

To take a closer look at this topic from a real-world perspective, Arora et al. explored data from nearly 120,000 patients with AFib and comorbid heart failure who were treated in 2016 and 2017. All data came from the nationwide Readmissions Database.

While 63,299 patients had heart failure with reduced ejection fraction (HFrEF), 56,395 had heart failure with preserved ejection fraction (HFpEF). AFib ablation was used to treat 2,841 patients with HFrEF and 1,790 patients with HFpEF.

Catheter ablation did not substantially reduce mortality or heart failure readmission after one year in either group when compared to patients who did not receive ablative therapy. However, AFib readmission after one year and all-cause readmission after one year did decrease in both groups.

“Notably, our study noted a remarkable decrease in AFib readmissions at one year,” the authors wrote. “This finding was sustained across both heart failure subtypes and may suggest a role for ablation in reducing the burden of morbidity that follows in AFib-related hospitalization Further study is required to determine if this reduction is reproducible and sustained over multiple years.”

The team did address some limitations of their work. For instance, any data taken from an administrative database runs the risk of being incorrect due to coding discrepancies. Also, the researchers didn’t have echocardiographic data, laboratory data or medication information for these patients, limiting their ability to see the complete picture.

In addition, longer follow-up periods would be helpful, especially since other studies covering similar ground have gone back two to three years following hospitalization instead of just one.