Impact of catheter ablation in patients with atrial flutter and concurrent heart failure

Chinmay Jani; Shilpkumar Arora; Zachary Zuzek; Rahul Jaswaney; Samarthkumar Thakkar; Harsh P Patel; Sopan Lahewala; Nirav Arora; Richard Josephson; Abhishek Deshmukh; Juan Viles-Gonzalez; Mohammed Najeeb Osman; Jayakumar Sahadevan; Brian D Hoit; Judith A Mackall

doi:10.1016/j.hroo.2020.11.005

Impact of catheter ablation in patients with atrial flutter and concurrent heart failure

Heart Rhythm O2. 2020 Nov 22;2(1):53-63. doi: 10.1016/j.hroo.2020.11.005. eCollection 2021 Feb.

Authors

Affiliations

¹ Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts.
² Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
³ Rochester General Hospital, Rochester, New York.
⁴ Louis A. Weiss Memorial Hospital, Chicago, Illinois.
⁵ University of Connecticut, Hartford, Connecticut.
⁶ Lamar University, Beaumont, Texas.
⁷ Mayo Clinic, Rochester, Minnesota.
⁸ Miami Cardiac and Vascular Institute/ Baptist Health South Florida, Miami, Florida.

Abstract

Background: No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF).

Objectives: To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF.

Methods: This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016-17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios.

Results: Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61-0.85, P < .001). HF readmission (HR 0.73, 95% CI 0.61-0.89, P = .001), all-cause mortality (HR 0.62, 95% CI 0.46-0.85, P = .003), and AF readmission (HR 0.63, 95% CI 0.48-0.82, P = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63-1.01, P = .065).

Conclusion: In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.

Keywords: Atrial flutter; Catheter ablation; Heart failure; Nationwide Readmissions Database.