The prognostic impact of catheter ablation for atrial fibrillation after heart failure hospitalization on long-term mortality – Propensity-score matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Iwanami ◽  
K Jujo ◽  
S Higuchi ◽  
T Abe ◽  
M Shoda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Left Ventricular ◽  
Lower Mortality ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background In the last two decades, catheter ablation (CA) for atrial fibrillation (AF) including pulmonary vein isolation (PVI) has been developed as a standard and effective treatment for atrial fibrillation (AF). In patients with chronic heart failure with reduced left ventricular ejection fraction (LVEF) (HFrEF), PVI CA for AF dramatically improves LVEF, resulting in better clinical prognoses. On the contrary, there still has been no data that PVI CA for AF improves the prognosis in heart failure patients with preserved LVEF (HFpEF). Purpose The aim of this study was to evaluate the prognostic impact of PVI CA for AF after the hospitalization due to decompensation of heart failureHF, focusing on LVEF. Methods From the database including 1,793 consecutive patients who were hospitalized due to congestive HF, we ultimately analyzed 624 AF patients who were discharged alive. They were assigned into two groups due that PVI CA for AF procedure done after the index hospitalization for HF; the PVI CA group (n=62) and Non-PVI CA group (n=562). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, LVEF, brain natriuretic peptide (BNP), blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) at discharge. Further analysis was performed separately in HFrEF (LVEF <50%) and HFpEF (LVEF >50%). The primary endpoint of this study was death from any cause. Results In unmatched patients, Kaplan-Meier analysis showed that patients in the PVI CA group had a significantly lower all-cause mortality than those in the Non-PVI CA group during 678 median follow-up period (Log-rank test: P=0.003, Figure A). In 96 PS-matched patients, patients in the PVI CA group still had lower mortality rate than those in the Non-PVI CA group (hazard ratio 0.28, 95% confidence interval 0.09–0.86, p=0.018, Figure B). When the whole study population was classified into HFrEF and HFpEF, HFrEF patients who received PVI showed a significantly lower mortality than those who did not (p=0.007); whereas, in HFpEF patients, PVI CA for AF did not make statistical difference in all-cause mortality (p=0.061). Conclusions In this observational study, PVI CA for AF may improve the mortality in HF patients with reduced LVEF. However, the prognostic impact of PVI CA for AF was not observed in HF patients with preserved LVEF. Funding Acknowledgement Type of funding source: None

Predictive value of atrial fibrillation catheter ablation on cognitive functions in patients with chronic heart failure

2021 ◽  
Vol 42 (2) ◽  
pp. 75-81
Author(s):  
T. V. Zolotarova ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Cognitive Functions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Atrial fibrillation (AF) directly leads to a cognitive function decline regardless of the cerebrovascular fatal events, but it is unclear whether the sinus rhythm restoration and reducing the AF burden can reduce the rate of this decreasement. Data on the effect of radiofrequency ablation on patients’ cognitive functions are conflicting and need to be studied. The aim of the study was to evaluate the prognostic value of atrial fibrillation radiofrequency catheter ablation on cognitive functions in patients with chronic heart failure with preserved left ventricular ejection fraction. The impact of AF radiofrequency catheter ablation on cognitive function in 136 patients (mean age 59.7 ± 8.6 years) with chronic heart failure with preserved left ventricular ejection fraction and compared with 58 patients in the control group (58.2 ± 8.1 years), which did not perform ablation and continued the tactics of drug antiarrhythmic therapy was investigated. Cognitive function was assessed using the Montreal Cognitive Test (MoCA) at the enrollment stage and 2 years follow-up. Decreased cognitive function was defined as a MoCA test score < 26 points, cognitive impairment < 23 points. Two years after the intervention, there was a positive dynamics (baseline MoCA test — 25,1 ± 2,48, 2-year follow-up — 26,51 ± 2,33, p < 0,001) in the ablation group and negative in the control group (25,47 ± 2,85 and 24,57 ± 3,61, respectively, p < 0,001). Pre-ablation cognitive impairment was significantly associated with improved cognitive function 2 years after AF ablation according to polynomial regression analysis. The obtained data suggest a probable positive effect of AF radiofrequency ablation on cognitive functions in patients with preserved left ventricular ejection fraction.

Abstract 16085: Digoxin is Associated With Increased Mortality in Patients With Atrial Fibrillation Without Concomitant Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maciej Tysarowski ◽  
Nigri Rafael ◽  
Hyoeun Kim ◽  
Emad Aziz
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: There is conflicting data on the effect of digoxin on all-cause mortality in patients with atrial fibrillation (AF), especially in patients with heart failure (HF). Hypothesis: We hypothesized that in patients with AF, mortality rates associated with digoxin treatment are different among patients with HF and without HF. Methods: We conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on all-cause mortality. We divided patients into two groups: with and without HF. We performed Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups. Results: Among 2179 consecutive patients, the median age was 73 ± 14 (table), 53% patient were male, 49% had HF, 19% were discharged on digoxin. Median left ventricular ejection fraction in the cohort was 60 (IQR 40-65). Among patients with HF, 35% had preserved, 18% had mid-range and 48% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.1 years. After adjustment, in patients with HF, there was no statistically significant difference in mortality between the digoxin subgroups ( A , HR=1.01 [95% CI 0.76 to 1.35], p=0.92). In contrast, after adjustment, in patients without HF there was a statistically significant increased mortality in the digoxin subgroup ( B , HR=2.23, [95% CI 1.42 to 3.51], p<0.001). Conclusions: Digoxin use was associated with increased mortality in patients with AF and without concomitant HF. This suggests that clinicians should be careful in prescribing digoxin for rate control in AF, especially in patients without concomitant HF.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

scholarly journals Drastic Cardiac Reverse Remodeling Following Catheter Ablation in Patients with Atrial Fibrillation and Heart Failure

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 511
Author(s):  
Takahisa Koi ◽  
Naoya Kataoka ◽  
Teruhiko Imamura ◽  
Koichiro Kinugawa
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Large Scale ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Ventricular Ejection Fraction

In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies.

scholarly journals Prognostic impact of free-fat mass index on elderly patients with acute decompensated heart failure: from CURE-HF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kanai ◽  
H Motoki ◽  
T Okano ◽  
K Kimura ◽  
M Minamisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Fat Mass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction ◽  
Fat Mass Index ◽  
All Cause Mortality

Abstract Background Free-Fat Mass Index (FFMI) is an indicator of malnutrition and sarcopenia. We hypothesized that low FFMI would be associated with worse prognosis in elderly patients with heart failure. Methods In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Free-Fat Mass Index was calculated dividing the square of the patients heights in meters into lean body mass. All-cause mortality (cardiovascular, non-cardiovascular) was followed-up by telephone interview and chart review. Results In our study cohort (median age, 78 [range 72–87]), FFMI was 16.7 [15.2, 18.0]. All-cause mortality was observed in 211 patients during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower FFMI was associated with all-cause mortality. Furthermore, FFMI was an independent predictor of mortality after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, low FFMI was associated with both cardiac and non-cardiac mortality in patients with HF with reduced ejection fraction (EF) (Log-rank p=0.002, p=0.013, respectively) (Figure). Furthermore, low FFMI was significantly associated non-cardiac death in patients with preserved EF (Log-rank p=0.033) (Figure). Conclusions Free-Fat Mass Index was significantly associated with mortality in elderly patients with HF. Funding Acknowledgement Type of funding source: None

scholarly journals Digoxin is Associated with Increased Mortality in Patients with Atrial Fibrillation without Concomitant Heart Failure

2020 ◽  
Author(s):  
Maciej Tysarowski ◽  
Rafael Nigri ◽  
Brijesh Patel ◽  
Giselle A Suero-Abreu ◽  
Balaji Pratap ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Treatment Groups ◽  
All Cause Mortality

Introduction: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is a significant risk factor for ischemic stroke and death. Digitalis has been used for more than 200 years to treat heart conditions, including AF, and its use remains controversial due to uncertain long-term morbidity and mortality. Methods: We conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on long-term all-cause mortality. Patients were divided into two groups: with and without heart failure (HF). We performed multivariable Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups. Results: Among 2179 consecutive patients hospitalized with AF, the median age was 73 ± 14, and 52.5% of patients were male, 49% had HF, and 18.8% were discharged on digoxin. Median left ventricular ejection fraction in the whole cohort was 60 (IQR 40-65). Among patients with HF, 34.5% had preserved, 17.3% had mid-range and 48.1% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.05 years. In patients without HF there was a statistically significant increased mortality in the digoxin subgroup after propensity score matching (HR = 2.23, 95% CI 1.42-3.51, p < 0.001). In contrast, in patients with HF, there was no difference in mortality between the treatment groups (p = 0.92). Conclusions: Digoxin use in our study was associated with increased mortality in patients with AF and without concomitant HF.

scholarly journals Meta-Analysis of Catheter Ablation versus Medical Therapy for Heart Failure Complicated with Atrial Fibrillation

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Xi Zhu ◽  
Yingbiao Wu ◽  
Zhongping Ning
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Objective. To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods. We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results. Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; P = 0.0007 ) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; P < 0.0001 ), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; P < 0.0001 ), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; P = 0.04 ). Conclusion. Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.

Sign in / Sign up

Export Citation Format

Share Document