Abstract
BACKGROUND: There is still a lack of evidence regarding the benefit of performing atrial fibrillation catheter ablation (AFCA) soon after the hospitalization for worsening heart failure (HF). OBJECTIVES: To evaluate the effectiveness of AFCA compared to the medical therapy alone in patients with AF and HF who were recently hospitalized for worsening HF. METHODS: Using the Korean National Health Insurance database, patients with new-onset AF between 2010 and 2020 were identified. Among these, patients who were admitted for worsening HF and did not underwent previous AFCA or AF surgery were included. Patients who underwent AFCA within 6-month after the HF admission was defined as the AFCA group, and the rest as the medical therapy alone group. The primary outcome was the composite of HF admission, heart transplantation, and death from any cause. Propensity score matching method was used. RESULTS: A total of 45,198 AF patients who were admitted for worsening HF were included. Only 0.4% of total study patients (n=168) underwent AFCA within 6-month after HF admission. Median duration from HF admission to AFCA was 3.7 months (interquartile range, 2.0 to 5.3). After a 1:5 propensity score matching of the AFCA group and medical therapy alone group, the baseline characteristics bewteen the two group were well-balanced. After the median follow-up of 34 months (interquartile range, 19 to 57), a primary outcome had occurred in 26 patients (incidence rate, 5.0 per 100 person-years) in the AFCA group and in 243 patients (incidence rate, 9.3 per 100 person-years) in the medical therapy alone group (hazard ratio [HR], 0.529, 95% confidence interval [CI], 0.353-0.793, p=0.002). AFCA group was associated with a lower risk of HF admission (HR 0.429, 95% CI 0.243-0.756, p=0.003) and composite of death from any cause and heart transplantation (HF 0.579, 95% CI 0.351-0.956, p=0.032) than the medical therapy alone group. CONCLUSION: In AF patients with HF recently hospitalized for worsening HF, AFCA within 6-month was associated with a lower risk of composite of HF admission, heart transplantation, and death from any cause compared to medical therapy alone. [Figure: see text] [Figure: see text]