Abstract 16766: Intraprocedural Ablation and Fluid Status Management in Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sahitya Allam ◽  
Evan Harmon ◽  
Sula Mazimba ◽  
James M Mangrum ◽  
Ilana Kutinsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tertiary Care ◽  
Fluid Management ◽  
Management Strategies ◽  
Clinical Trial Data ◽  
Posterior Wall ◽  
Fluid Status ◽  
Volume Output

Background: Recent randomized clinical trial data has supported catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). Ablation and fluid management strategies could impact periprocedural outcomes especially in HF patients. Methods: We conducted a single-center retrospective analysis of 200 consecutive patients with and without HF undergoing CA at a tertiary care academic center from July 2017 through June 2018. HF was defined as any EF < 40%, prior inpatient admission for HF exacerbation, or ambulatory management of HF confirmed by independent chart review. Diuretic regimens were reported as furosemide equivalent. Results: Among 200 patients, 65 (32.5%) had HF and 135 (67.5%) did not. HF patients had longer mean procedure times (299.8 ± 96 min vs 268.4 ± 96 min, p = 0.03) and were more likely to require mitral isthmus (p < 0.001), posterior wall isolation (p = 0.002), and cavotriscupid isthmus (p = 0.004) ablations. There were no differences between the HF vs. non-HF groups’ intraprocedural volume intake, intraprocedural volume output, net fluid status, or intraprocedural diuretic dose (Table 1). HF patients received higher doses of IV (41.5 ± 43.0 mg vs 23.6 ± 11.8 mg, p = 0.007) and PO (43.2 ± 16.7 mg vs 26.7 ± 10.0 mg, p < 0.001) postprocedural diuretic. There were no differences in the rates of major in-hospital complications (Table 1). In a multivariable regression analysis adjusted for procedural covariates, there were higher proportions of posterior wall isolation (p = 0.01) as well as postprocedural PO (p = 0.01) and IV diuretic (p = 0.002) administration in the HF cohort. Conclusion: Intraprocedural volume and diuretic management was similar between HF and non-HF patients undergoing CA of AF, though HF patients tended to receive more aggressive diuresis post procedurally with no difference in complications. Table 1. Intra- and post-procedural management and outcomes in HF vs non-HF patients undergoing CA for AF

Atrial Fibrillation in Heart Failure Patients

2009 ◽  
Vol 5 (1) ◽  
pp. 41
Author(s):  
Michalis Efremidis ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Clinical Trial Data ◽  
Cardiac Resynchronisation Therapy ◽  
Controlled Clinical Trial ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Randomised Controlled ◽  
Near Future

There is a sinister synergism between atrial fibrillation (AF) and heart failure (HF). These common cardiovascular conditions often co-exist and result in significant morbidity and mortality. Despite the extensive amount of research and literature about each of these disorders separately, randomised controlled clinical trial data concerning the management of AF in patients with HF are lacking. The recently published Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial elucidated the matter of rhythm versus rate control. In addition, non-pharmacological treatment approaches such as catheter ablation of AF and cardiac resynchronisation therapy are rapidly growing and are likely to alter AF management in HF patients in the near future.

scholarly journals Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Joung ◽  
P.S Yang ◽  
J.H Sung ◽  
E Jang ◽  
H.T Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Catheter Ablation ◽  
Real World ◽  
Background Characteristics ◽  
Risk Of Death ◽  
Frail Patients ◽  
Korean National Health Insurance

Abstract Background It is unclear whether catheter ablation is beneficial in frail patients with AF. Purpose This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF). Methods Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups. Results After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P&lt;0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation. Conclussion Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies. Funding Acknowledgement Type of funding source: None

scholarly journals B-PO03-114 ATRIAL FIBRILLATION AND HEART FAILURE WITH PRESERVED VERSUS REDUCED EJECTION FRACTION: OUTCOMES AFTER CATHETER ABLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S235
Author(s):  
Amrita Krishnamurthy ◽  
Parag Goyal ◽  
Steven M. Markowitz ◽  
Christopher F. Liu ◽  
George Thomas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Reduced Ejection Fraction

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O.M Aldaas ◽  
F Lupercio ◽  
C.L Malladi ◽  
P.S Mylavarapu ◽  
D Darden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear. Purpose To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF. Methods We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR&lt;1.0 favors the HFpEF group. Results Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up. Conclusion Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF. Funding Acknowledgement Type of funding source: None

B-Type natriuretic peptide predicts major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kato ◽  
K Usuda ◽  
H Tada ◽  
T Tsuda ◽  
K Takeuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Natriuretic Peptide ◽  
Cardiovascular Events ◽  
Curve Analysis ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Abstract Background High plasma B-Type natriuretic peptide (BNP) level is associated with cardiac events or stroke in patients with atrial fibrillation (AF). However, it is still unknown whether BNP predicts worse clinical outcomes after catheter ablation ofAF. Purpose We aimed to see if plasma BNP level is associated with major adverse cardiac and cerebrovascular events (MACCE) after catheter ablation of AF. Methods We retrospectively analyzed 1,853 participants (73.1% men, mean age 63.3±10.3 years, 60.7% paroxysmal AF) who received first catheter ablation of AF with pre-ablation plasma BNP level measurement and completed follow-up more than 3 months after the procedure from AF Frontier Ablation Registry, a multicenter cohort study in Japan. We evaluated an association between plasma BNP level before catheter ablation and first MACCE in cox-regression hazard models adjusted for known risk factors. MACCE were defined as stroke/transient ischemic attack (TIA), cardiovascular events or all-cause death. Results The mean plasma BNP level was 120.2±3.7 pg/mL. During a mean follow-up period of 21.9 months, 57 patients (3.1%) suffered MACCE (ischemic stroke 8 [14.0%], hemorrhagic stroke 5 [8.8%], TIA 5 [8.8%], hospitalization for heart failure 11 [19.2%], acute coronary syndrome 9 [15.8%], hospitalization for other cardiovascular events 8 [14.0%] and all-cause death 11 [19.2%]). Plasma BNP level of patients with MACCE were significantly higher than those without MACCE (291.7±47.0 vs 114.7±3.42 pg/mL, P&lt;0.001). Multivariate analysis revealed that plasma BNP level (hazard ratio [HR] per 10 pg/mL increase 1.014; 95% confidence interval [CI] 1.005–1.023; P=0.001), baseline age (HR 1.052; 95% CI 1.022–1.084; P=0.001), heart failure (HR 2.698; 95% CI 1.512–4.815; P=0.001), old myocardial infarction (HR 3.593; 95% CI 1.675–7.708; P=0.001) and non-ischemic cardiomyopathy (HR 2.676; 95% CI 1.337 - 5.355; P=0.005) were independently associated with MACCE. At receiver-operating characteristic curve analysis, plasma BNP level before catheter ablation ≥162.7 pg/mL was the best threshold to predict MACCE (area under the curve: 0.71). Kaplan-Meier curve analysis (Figure) showed that the cumulative incidence of MACCE was significantly higher in patients with a BNP ≥162.7 pg/mL than in those with a BNP below 162.7 pg/mL (HR 4.85; 95% CI 2.86–8.21; P&lt;0.001). Conclusions Elevation of plasma BNP level was independently related to the increased risk of MACCE after catheter ablation ofAF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bristol-Meiers Squibb

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.

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