Adverse outcomes of atrial fibrillation ablation in heart failure patients with and without cardiac amyloidosis: a Nationwide Readmissions Database analysis (2015–2019)

Abstract

Atrial fibrillation (AF) in patients with cardiac amyloidosis (CA) has been linked with a worse prognosis. The current study aimed to determine the outcomes of AF catheter ablation in patients with CA. The National Readmission Database (NRD) 2015-2019 was used to identify patients with AF and concomitant heart failure (HF). Among these, patients who underwent catheter ablation were classified into two groups, patients with and without CA. The adjusted odds ratio (aOR) of index-admission and 30-day readmission outcomes were calculated using a propensity score matched (PSM) analysis. A total of 148,134 patients with AF undergoing catheter ablation were identified on crude analysis. Using PSM analysis, 616 patients (293 CA-AF, 323 no-CA-AF) were selected based on a balanced distribution of baseline comorbidities. At index admission, AF ablation in patients with CA was associated with significantly higher adjusted odds of net adverse clinical events (NACE) (aOR 4.21, 95% CI 1.7-5.20), in-hospital mortality (aOR 9.03, 95% CI 1.12-72.70), and pericardial effusion (aOR 3.30, 95% CI 1.57-6.93) compared with non-CA AF. There was no significant difference in the odds of stroke, cardiac tamponade, and major bleeding between the two groups. At 30-day readmission, the incidence of NACE, and mortality remained high in patients undergoing AF ablation in CA. Compared with non-CA, AF ablation in CA patients is associated with relatively higher in-hospital all-cause mortality and net adverse events both at index admission and up to 30-day follow-up.

How to treat atrial fibrillation in patients with cardiac amyloidosis

“…Using a nationwide database, Ullah et al . 1 demonstrated that AF ablation in patients with cardiac amyloidosis was associated with higher in-hospital all-cause mortality and net adverse clinical events both during the index hospitalization and at 30-day follow-up as compared with background-matched heart failure patients without cardiac amyloidosis. Several concerns are raised.…”

Atrial fibrillation in patients with cardiac amyloidosis and heart failure: a desperate cause?

“… 6 In their study, Ullah et al . 5 report no significant difference in the odds of stroke, cardiac tamponade, and major bleeding between the two groups, but the respective rate of fatal events for each specific category of adverse events is unknown. After AF ablation, the vast majority of deaths from periprocedural complications occur (with the exception of atrio-oesophageal fistula) within a few days of the procedure.…”

“…However, Ullah et al . 5 observed significantly higher all-cause mortality at both index admission [odds ratio (OR = 9.03)] and 30-day readmission (OR = 4.28) in patients with CA.…”

“…In this issue of the European Heart Journal Open , Ullah et al . 5 use global health data to obtain a sufficient population to draw initial conclusions about the early outcomes of AF ablation in patients with CA. To conduct this study, data (September 2015 to November 2019) were extracted from the National Readmissions Database (>15 million discharge data points from 22 US states) to identify 148 133 patients with AF and concomitant HF who underwent AF catheter ablation.…”

Editors’ highlight picks from 2023 in EHJ Open

“…In Valvular Heart Disease , EHJ Open presented a State-of-the-Art review on the association of CA with aortic stenosis, from pathophysiology to treatment. 18 Furthermore, in Arrhythmia & Electrophysiology , Ullah et al used nationwide health data to conclude that atrial fibrillation ablation was associated with significantly higher net adverse clinical events in patients with CA, 19 albeit atrial fibrillation catheter ablation remains effective to maintain sinus rhythm in patients with CA. 20 Finally, novel findings on Vascular & Cardiac Imaging of CA include a suggested novel echocardiographic risk score 21 and CA prognostic prediction by cardiac magnetic resonance imaging (cMRI).…”