Long-term effectiveness of catheter ablation in patients with atrial fibrillation and heart failure

Abstract

Aims Randomized trials suggest reductions in all-cause mortality and heart failure (HF) rehospitalizations with catheter ablation (CA) in patients with atrial fibrillation (AF) and HF. Whether these results can be replicated in a real-world population with long-term follow-up or varies over time is unknown. We sought to evaluate the long-term effectiveness of CA in reducing the incidence of all-cause mortality, HF hospitalizations, stroke, and major bleeding in AF–HF patients. Methods and results In a cohort of patients newly diagnosed with AF–HF in Quebec, Canada (2000–2017), CA patients were matched 1:2 to controls on time and frequency of hospitalizations. Confounders were controlled for using inverse probability of treatment weighting. Multivariable Cox models adjusted for the presence of cardiac electronic implantable devices and medication use during follow-up, and the effect of time since CA was modelled with B-splines. For non-fatal outcomes, the Lunn–McNeil approach was used to account for the competing risk of death. Among 101 933 AF–HF patients, 451 underwent CA and were matched to 899 controls. Over a median follow-up of 3.8 years, CA was associated with a statistically significant reduction in all-cause mortality [hazard ratio 0.4 (95% confidence interval 0.2–0.7)], but no difference in stroke or major bleeding. The hazard of HF rehospitalization for CA patients, relative to non-CA patients, varied with time since CA (P = 0.01), with a reduction in HF rehospitalizations until approximately 3 years post-CA. Conclusion Compared with matched non-CA patients, CA was associated with a long-term reduction in all-cause mortality and a reduction in HF rehospitalizations until 3 years post-CA.

Cost‐Utility of Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: An Economic Evaluation

“…Based on a recent well‐conducted observational study of catheter ablation in patients with AF and HF, the duration of effectiveness for CA on mortality and HF requiring hospitalization was assumed to be 3 years. 26 This is similar to the median follow‐up duration of CASTLE‐AF, which was 38 months. 14 …”

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

“…645 A recent observational study showed that catheter ablation was associated with a long-term reduction in all-cause mortality and HF rehospitalizations. 646 There are no data showing a mortality benefit in patients with HF and preserved EF. The large multicentre Canadian randomized ablation-based Randomized Ablation-Based Atrial Fibrillation Rhythm Control vs Rate Control Trial in Patients With Heart Failure and High Burden Atrial Fibrillation (RAFT-AF) study has closed enrollment and is due to report later this year (NCT01420393).…”

Atrial Fibrillation Ablation in Heart Failure Patients

“…In 2020, Samuel et al provided a study [23] on catheter ablation in patients with HF and AF in a real-world setting with long-term follow-up within a Canadian population. Among 101,933 AF-HF patients, 451 (0.44%) underwent catheter ablation and were matched to 899 controls.…”