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Europace. 2016 Apr;18(4):521-30. doi: 10.1093/europace/euv215. Epub 2015 Aug 26.

Incidence and risk factors for symptomatic heart failure after catheter ablation of atrial fibrillation and atrial flutter.

Author information

1
Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
2
Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA mjoseph2@bidmc.harvard.edu.

Abstract

AIMS:

To determine the incidence and risk factors for development of symptomatic heart failure (HF) following catheter ablation for atrial fibrillation (AF) and atrial flutter.

METHODS AND RESULTS:

We prospectively enrolled consecutive patients undergoing pulmonary vein isolation (PVI) or cavotricuspid isthmus (CTI) ablation between November 2013 and June 2014. Post-discharge symptoms were assessed via telephone follow-up and clinic visits. The primary outcome was symptomatic HF requiring treatment with new/increased diuretic dosing. Secondary outcomes were prolonged index hospitalization and readmission for HF ≤30 days. Univariate and multivariable logistic regressions were used to assess the relationship between patient/procedural characteristic and post-ablation HF. Among 111 PVI patients [median age 62.0 years; left ventricular ejection fraction (LVEF) 55%], 29 patients (26.1%) developed symptomatic HF, 6 patients (5.4%) required prolonged index hospitalization, and 8 patients (7.2%) were readmitted for HF. In univariate analyses, persistent AF [odds ratio (OR) 2.97, P = 0.02], AF at start of the procedure (OR 2.99, P = 0.01), additional ablation lines (OR 11.07, P < 0.0001), and final left atrial pressure (OR 1.10 per 1 mmHg increase, P = 0.02) were associated with HF development. Peri-procedural diuresis, net fluid balance, and LVEF were not correlated. In multivariable analyses, only additional ablation lines (ORadj 9.17, P = 0.007) were independently associated with post-ablation HF. Six patients (16.7%) developed HF after CTI ablation.

CONCLUSION:

A 26.1% of patients undergoing PVI and 16.7% of patients undergoing CTI ablation developed symptomatic HF when prospectively and uniformly assessed. 12.6% of patients experienced prolonged index hospitalizations or readmission for management of HF within 1 week after PVI. Improved understanding of risk factors for post-ablation HF may be critical in developing strategies to address during AF ablation.

KEYWORDS:

Ablation; Atrial fibrillation; Atrial flutter; Heart failure; Pulmonary oedema; Pulmonary vein isolation

PMID:
26311563
DOI:
10.1093/europace/euv215
[Indexed for MEDLINE]

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