Abstract 17132: Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Manyoo Agarwal ◽  
Brijesh Patel ◽  
Lohit Garg ◽  
Mahek Shah ◽  
Rami Khouzam ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Complication Rates ◽  
Af Ablation ◽  
Southern Us ◽  
Comorbidity Burden

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend<0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend<0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend<0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined.

Abstract 330: Thirty-day Incidence of Cardiac Tamponade and Mortality Following Catheter or Surgical Ablation of Atrial Fibrillation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
John F Scoggins ◽  
Christie Teigland ◽  
Laura B Meisnere
Keyword(s):  
Atrial Fibrillation ◽  
Mortality Rate ◽  
Cardiac Tamponade ◽  
Large Population ◽  
Safety Information ◽  
Surgical Patient ◽  
Administrative Claims ◽  
Complication Rates ◽  
Age Group ◽  
Af Ablation

Background: The risks of cardiac tamponade and mortality during the first 30 days following catheter or surgical atrial fibrillation (AF) ablation are not well known. Previous large population studies have been limited to in-hospital complication rates and might significantly underestimate the risks of these procedures. Methods: This population based retrospective cohort study was conducted using a large national representative administrative claims database, the Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®). Thirty-day incidence rates of cardiac tamponade and mortality were calculated and compared by type of procedure (i.e. catheter or surgical), patient gender and age. We analyzed 38,974 AF ablation procedures (catheter: 30,758, 78.9%; surgical: 8,216, 21.1%; age 80 or older: 6,077, 15.6%; 65 to 79: 19,572, 50.2%; 50 to 64: 10,243, 26.3%; 18 to 49: 3,082, 7.9%) performed on 35,754 patients (men: 21,879, 61.2%; women: 13,875, 38.8%) from 2007 to 2012. Results: Thirty-day incidence of cardiac tamponade was 1.74% and differed significantly by type of procedure (catheter: 1.51% vs. surgical: 2.62%, p<0.001) and gender (men: 1.60% vs. women: 1.96%, p=0.010), but not by age group (18-49: 1.49%; 50-64: 1.77%; 65-79: 1.91%; 80 or older: 1.28%, p=0.425). The thirty-day mortality rate was 1.15% and differed significantly by type of procedure (catheter: 0.70% vs. surgical: 2.76%, p<0.001), but not by gender (men: 1.06% vs. women: 1.29%, p=0.058). The mortality rate did not differ significantly from the youngest age group to the next oldest (18 to 49: 0.33% vs. 50 to 64: 0.21%, p=0.315), but increased significantly for the oldest age groups (65 to 79: 1.28%; 80 or older: 2.75%, p<0.001). Conclusion: The 30-day risks of both cardiac tamponade and mortality following catheter AF ablation are greater than the in-hospital rates reported in a previous study. Surgical AF ablation has significantly higher 30-day rates of both cardiac tamponade and mortality, compared to catheter AF ablation. The risk of cardiac tamponade is greater for women than men, but does not vary significantly by age group. Conversely, the risk of mortality is greater for patients age 65 and older, but is not significantly different for women compared to men. These findings provide new comparative safety information that can help inform optimal treatment practices and could serve as the basis of a physician or facility quality measure designed to evaluate relative performance and provide benchmarks to support both consumer choice and quality improvement efforts.

486Are the results of the CASTLE-AF trial reproducible in the real life? Clinical outcomes after catheter ablation for atrial fibrillation with heart failure in a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bisson ◽  
F Mondout ◽  
J Herbert ◽  
N Clementy ◽  
B Pierre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Catheter Ablation ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Af Ablation ◽  
Risk Of Death ◽  
Systèmes D’Information ◽  
Event Rates

Abstract Background Catheter ablation for atrial fibrillation (AF) is a validated therapy for patients with symptomatic AF to prevent recurrences. The CASTLE AF trial indicated that ablation for AF in patients with heart failure (HF) was associated with a lower rate of death from any cause or hospitalization for worsening HF than was medical therapy. The purpose of our study was to compare the incidence of these events in AF patients with HF after AF catheter ablation versus those not treated with AF ablation at a nationwide level in centers possibly less well experienced. Methods This French longitudinal cohort study was based on the national hospitalization PMSI (Programme de Médicalisation des Systèmes d'Information) database covering hospital care from the entire population. We included all patients, over 18 years old, with AF and HF from January 2010 to December 2015. Crude event rates were ascertained and hazard ratios (HR) were estimated using Cox proportional hazards risk model. Propensity-matched Cox regression was also used to compare event rates according to AF ablation usage status. Results Among the 261,449 patients identified with AF and HF, 1,270 patients were treated with AF ablation (24% female, mean age 63±10 yo) and 260,179 did not have AF ablation (45% female, mean age 79±11 yo). During follow-up (417±502 days), there were 56,981 hospitalizations with a primary diagnosis of HF and 81,393 deaths were recorded. Incidence of hospitalization for HF was significantly lower in patients with AF ablation than in those with no ablation (13.74% vs 51.11% person per year respectively, p<0.0001). Incidence of death was also significantly lower in patients with AF ablation than in those with no ablation (6.07% vs 27.42% person per year respectively, p<0.0001). These associations were confirmed in a multivariable analysis after adjustment on age and other comorbidities (HR 0.33, 95% CI 0.28–0.39, p<0.0001 for HF and HR 0.38, 95% CI 0.31–0.48, p<0.0001 for all-cause death). After 1:1 propensity score matching, AF ablation was also associated with a lower risk of hospitalization for HF (HR 0.38, 95% CI 0.31–0.47, p<0.0001) and a lower risk of death (HR 0.54, 95% CI 0.42–0.70, p<0.0001). Conclusion In the nationwide analysis of unselected AF patients with HF seen in hospitals, AF ablation was independently associated with a lower risk of hospitalization for HF and death. This provides “real world” data consistent with those observed in recent trials with lower numbers of highly selected patients

scholarly journals Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Karim ◽  
N Kozhuharov ◽  
J Jarman ◽  
S Furniss ◽  
R Veasey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
De Novo ◽  
Lv Function ◽  
P Value ◽  
Complication Rates ◽  
Success Rates ◽  
Af Ablation ◽  
Funding Sources ◽  
Procedural Success

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Sven Knecht and the International Octogenarian AF ablation group Background Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group. Purpose Investigation of complications & outcomes in octogenarians undergoing CA for AF. Methods Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged &lt;80 years.  The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure. Results 216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged &lt;80 years (62.4 ± 9.5 years, 34.7% females), p &lt;0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively.  17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively. Conclusion In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged &lt; 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) &lt; 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) &lt; 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 &lt; 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073

Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation

2018 ◽  
Vol 29 (6) ◽  
pp. 854-860 ◽  
Author(s):  
Rahul G. Muthalaly ◽  
Roy M. John ◽  
Benjamin Schaeffer ◽  
Shinichi Tanigawa ◽  
Tomofumi Nakamura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Temporal Trends ◽  
Complication Rates

scholarly journals Reduction of mortality by catheter ablation in real-world atrial fibrillation patients with heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pil-Sung Yang ◽  
Daehoon Kim ◽  
Jung-Hoon Sung ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Real World ◽  
The Elderly ◽  
Cardiovascular Death ◽  
Af Ablation ◽  
Patients With Heart Failure ◽  
Korean National Health Insurance ◽  
Reduction Of Mortality

AbstractWhether catheter ablation for atrial fibrillation (AF) improves survival and affects other outcomes in real-world heart failure (HF) patients is unclear. This study aimed to evaluate whether ablation reduces death, and other outcomes in real-world AF patients with HF. Among 834,735 patients with AF from 2006 to 2015 in the Korean National Health Insurance Service database, 3173 HF patients underwent AF ablation. Propensity score weighting was used to correct for differences between the groups. During median 54 months follow-up, the risk of all-cause death in ablated patients was less than half of that in patients with medical therapy (2.8 vs. 6.2 per 100 person-years; hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.27–0.65, p < 0.001). Ablation was related with lower risk of cardiovascular death (HR 0.38, 95% CI 0.32–0.62, p < 0.001), HF admission (HR 0.39, 95% CI 0.33–0.46, p < 0.001) and stroke/systemic embolism (HR 0.44, 95% CI 0.37–0.53, p < 0.001). In subgroup analysis, the risk of all-cause death was reduced in most subgroups except in the elderly (≥ 75 years) and strictly anticoagulated patients. Ablation may be associated with reduced risk of all-cause death and cardiovascular death in real-world AF patients with HF, supporting the role of AF ablation in patients with HF.

Impact of outflow tract obstruction in the management of atrial fibrillation in hypertrophic cardiomyopathy: insights from the national readmission database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Narasimhan ◽  
L Wu ◽  
K Ho ◽  
M Amreia ◽  
A Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Catheter Ablation ◽  
Outflow Tract ◽  
High Risk Population ◽  
Atrial Arrhythmias ◽  
Af Ablation ◽  
Arrhythmogenic Substrate ◽  
National Readmission Database

Abstract Background Atrial fibrillation (AF) is commonly encountered in patients with Hypertrophic Cardiomyopathy (HCM). Presence of AF in this high risk population is detrimental due to its effect on hemodynamics, diastolic function and potential induction of ventricular tachyarrhythmias. For these reasons a rhythm control strategy is highly desirable, and yet catheter ablation of AF is consistently inefficacious with poorer overall outcomes. We hypothesize that in HCM presence of outflow tract obstruction by virtue of its effect on left atrial hemodynamics, altered circulatory flow patterns in the pulmonary veins, and stretch related triggered activities would create an arrhythmogenic substrate, and have significant impact on the outcomes of catheter ablation of AF. In this study, we aimed to evaluate AF ablation outcomes based on the presence or absence of outflow tract obstructions in patients with HCM. Methods We conducted a retrospective study using the AHRQ-HCUP National Readmission Database for the years 2016–17. All adults (≥18 years) with HCM undergoing AF ablation procedures were identified using ICD-9 codes. The cohort was divided into two groups; Obstructive HCM (Group A) and Non-Obstructive HCM (Group B) Multivariate regression analysis was utilized to adjust for confounders. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results From a total of 71,451,419 patients in the NRD registry, 97 patients with HCM were identified and formed the study cohort. When divided based on the presence or absence of outflow tract obstruction, there were 25 patients with Obstructive HCM and 72 patients with Non-obstructive HCM. Both groups were similar in clinical characteristics including CHADVASc scores and Charlson Comobidity indices as outlined in Table 1. Procedural outcome analysis revealed higher 30-day cardiac readmissions in the Obstructive HCM group compared to Non-obstructive HCM (25.2% vs 7.97%, p=0.049). The Obstructive HCM group had higher rates of atrial arrhythmias, 57.97%, compared to 32.44% in the non-obstructive HCM group, and heart failure exacerbations, 41.27% vs 25.82%. However, both indices did not reach statistical significance. The procedural complications rates tended to be higher in the non-obstructive HCM group, 10.8% vs. 5.6% in the Obstructive HCM group (p=0.54). Conclusions Presence of an obstructive component to HCM is associated with significantly increased short term cardiac readmissions predominantly driven by recurrent atrial arrhythmias and heart failure. These findings suggest negative influence of altered cardiac hemodynamics related to outflow tract obstruction on atrial arrhythmias. The arrhythmogenic substrate of HCM may therefore be different and less amenable to catheter ablation. HCM ablation outcomes Funding Acknowledgement Type of funding source: None

scholarly journals E/E′ Is a New Independent Predictor of Recovered Ejection Fraction in Patients With Systolic Heart Failure Undergoing Ablation for Atrial Fibrillation

2022 ◽  
Vol 8 ◽  
Author(s):  
Minghui Yang ◽  
Rongfeng Zhang ◽  
Huamin Tang ◽  
Guocao Li ◽  
Xumin Guan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Systolic Heart Failure ◽  
Characteristic Analysis ◽  
Reduced Ejection Fraction ◽  
Af Ablation

Aims: Catheter ablation should be considered in patients with atrial fibrillation (AF) and with heart failure (HF) with reduced ejection fraction (EF; HFrEF) to improve survival and reduce heart failure hospitalization. Careful patient selection for AF ablation is key to achieving similar outcome benefits. However, limited data exist regarding predictors of recovered ejection fraction. We aimed to evaluate the predictors of recovered ejection fraction in consecutive patients with HF undergoing AF ablation.Methods and Results: A total of 156 patients [67.3% men, median age 63 (11)] with AF and HF underwent initial catheter ablation between September 2017 and October 2019 in the First Affiliated Hospital of Dalian Medical University. Overall, the percentage of recovered ejection fractions was 72.3%. Recovered EFs were associated with a 39% reduction in all-cause hospitalization compared to non-recovered EFs at the 1-year follow-up [23.8 vs. 62.8 (odds ratio) OR 2.09 (1.40–3.12), P &lt; 0.001]. Univariate analysis for recovered EFs showed that diabetes (P = 0.083), prevalent HF (P = 0.014), prevalent AF (P = 0.051), LVEF (P = 0.022), and E/E′ (P = 0.001) were associated with EF improvement. Multivariate analysis showed that the only independent predictor of EF recovery was E/E′ [OR 1.13 (1.03–1.24); P = 0.011]. A receiver operating characteristic analysis determined that the suitable cut-off value for E/E′ was 15 (sensitivity 38.7%, specificity 89.2%, the area under curve 0.704).Conclusions: Ejection fraction (EF) recovery occurred in 72.3% of patients, associated with a 39% reduction in all-cause hospitalization compared to the non-recovered EFs in our cohort. The only independent predictor of recovered EF was E/E′ &lt; 15 in our series.

P5650Improvement in ejection fraction predicts heart failure after catheter ablation for atrial fibrillation in patients with left ventricular systolic dysfunction: from the KPAF registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Fujimoto ◽  
N Doi ◽  
K Hirai ◽  
M Naito ◽  
S Shizuta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Af Ablation ◽  
Study Population ◽  
The Impact

Abstract Introduction The presence of atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF) is associated with increased risks of mortality and hospitalization for heart failure (HF). Although prior studies reported that catheter ablation (CA) for AF in low LVEF patients reduced risks of all-cause mortality and HF hospitalization, the predictors of worsening HF after ablation has not been adequately evaluated. Purpose The purpose of this study was to investigate the impact of improvement in LVEF after AF ablation on the incidence of subsequent HF hospitalization in patients with low LVEF. Methods The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multicenter registry enrolling 5,013 consecutive patients undergoing first-time ablation for AF. The current study population consisted of 1,031 patients with reduced LVEF of <60%. We divided the study population into 3 groups according to LVEF at follow-up; 678 patients (65.8%) with improved LVEF (≥5 U change in LVEF), 288 patients (27.9%) with unchanged LVEF (−5 U ≤ change in LVEF <5 U) and 65 patients (6.3%) with worsened LVEF (<−5 U change in LVEF). Results During the median follow-up of 1067 [879–1226] days, patients improved LVEF had lower rate of HF hospitalization, compared with those with unchanged and worsened LVEF (2.1%, 8.0%, and 21.5%, respectively, P<0.0001). Recurrent atrial tachyarrhythmias were documented in 43.5%, 47.2% and 67.7%, respectively (P=0.0008). Figure 1 Conclusion Among patients with reduced LVEF undergoing AF ablation, patients with subsequently improved LVEF in association with maintained sinus rhythm had markedly lower risk of HF hospitalization during follow-up as compared with those with unchanged or worsened LVEF.

66Clinical outcomes after catheter ablation for atrial fibrillation in elderly patients: a French nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bisson ◽  
F Mondout ◽  
A Bodin ◽  
N Clementy ◽  
B Pierre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Catheter Ablation ◽  
Multivariable Analysis ◽  
Primary Diagnosis ◽  
Af Ablation ◽  
Patients With Heart Failure ◽  
Systèmes D’Information

Abstract Catheter ablation for atrial fibrillation (AF) is a validated therapy for patients with symptomatic AF to prevent recurrences. The CASTLE AF trial indicated that ablation for AF in patients with heart failure was associated with a lower rate of death from any cause or hospitalization for worsening heart failure than was medical therapy. However, the benefit of AF ablation was not significant in older patients (>65 yo). The purpose of our study was to compare the incidence of these events in patients after AF catheter ablation versus patients not treated with AF ablation at a nationwide level and to analyse whether the possible benefit with AF ablation may differ among patients younger or older than 75 yo. Methods This French longitudinal cohort study was based on the national hospitalization PMSI (Programme de Médicalisation des Systèmes d'Information) database covering hospital care from the entire population. We included all patients, over 18 years old, with AF from January 2010 to December 2015. Results Among the 1,663,284 patients identified with AF, 28,018 patients were treated with AF ablation (28% female, mean age 60±10 yo) and 1,635,266 did not have AF ablation (48% female, mean age 78±11 yo). Among those treated with AF ablation, 1,605/28,018 patients (5.7%) were aged >75 yo. During follow-up (456±546 days), hospitalization with a primary diagnosis of HF and death were recorded. Incidences of hospitalization for HF and death were significantly lower in AF ablation group (respectively 6.09% vs 13.29% person per year, p<0.0001, and 1.49% vs 17.11% person per year, p<0.0001). These associations were confirmed in a multivariable analysis after adjustment on age and other comorbidities (HR 0.66, 95% CI 0.63–0.69, p<0.0001 for HF and HR 0.21, 95% CI 0.19–0.23, p<0.0001 for all-cause death). Results were significant and relatively similar whether patients were aged below or above 75 yo: HR 0.63, 95% CI 0.60–0.66, p<0.0001 when age <75 yo and HR 0.60, 95% CI 0.51–0.70, p<0.0001 when age >75 yo for hospitalization for HF; HR 0.21, 95% CI 0.19–0.24, p<0.0001 when age <75 yo and HR 0.36, 95% CI 0.29–0.45, p<0.0001 when age >75 yo for all-cause death. Conclusion In the nationwide analysis of unselected AF patients seen in hospitals, AF ablation was independently associated with a lower risk of hospitalization for HF and death whether patients were aged below or above 75 yo.

Sign in / Sign up

Export Citation Format

Share Document