P1418Heart failure and atrial fibrillation: clinical, prognostic and echocardiographic outcome

Abstract

Background Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients is associated with a lower rate of cardiac events compared to medical therapy. Purpose This study deals with the clinical, echocardiographic and prognostic outcomes in these patients. Methods From a single center 47 patients with AF, HF and left ventricular ejection fraction (LVEF) <50%, underwent CA. The primary endpoints were NYHA functional class, LVEF and MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) Risk score before the procedure and after 12 months. Results The median age of patients was 59 years; 49% had paroxysmal AF. At 12-month a significant improvement of NYHA class (median before II [interquartile range (IQR) II-III] vs median after I [IQR I-II]) and of LVEF (median before 44% [IQR 37-47] vs median after 55% [IQR49-57]) was observed (p-value 0.000). The MAGGIC 1-year and 3-year probability of death was estimated before (mean score 13 [IQR 11-17]) and at 12-month (mean score 11 [IQR 8-13]) showing a significant decrease in the probability of death (p-value 0.000). At 12-month patients with reduced LVEF before the ablation had more HF hospitalizations than HF mid-range patients (p-value 0.035). Coronary artery disease (CAD) (HR 5, p-value 0.035) and MAGGIC score (HR 1.2, p-value 0.030) were predictors of HF hospitalization. Conclusion CA for AF in HF patients was associated with a significant improvement of NYHA functional class and LVEF and a higher life expectation. CAD history, LVEF <40% and MAGGIC score before ablation were predictors of HF hospitalization at 12-month follow-up.