The impact of rhythm outcomes on heart failure (HF) hospitalizations remains unknown
after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). We sought
to elucidate whether AF recurrence was associated with HF hospitalizations after AF
RFCA. We conducted a large-scale, prospective, multicenter, observational study (Kansai
Plus Atrial Fibrillation Registry), enrolling 5,010 consecutive patients (age 64 ±
10 years, 27.3% female, and 35.7% nonparoxysmal AF) who underwent an initial AF RFCA
at 26 centers. The median follow-up duration was 2.9 years. The cumulative 3-year
incidence of HF hospitalizations after the initial RFCA was 1.84% (0.69%/year). Hospitalized
patients with HF were older with a higher prevalence of nonparoxysmal AF, renal dysfunction,
diabetes, and underlying heart disease pre-RFCA. HF hospitalizations occurred more
often in patients with than without recurrences (3.27 vs 0.84%, log-rank p <0.0001).
After adjusting for confounders using a Cox model, AF recurrence remained an independent
predictor of HF hospitalizations (hazard ratio [HR] 2.84, 95% confidence interval
[CI] 1.80 to 4.47, p <0.0001). AF recurrence was a distinct HF hospitalization risk
in patients with a left ventricular ejection fraction ≥50% (HR 4.54, 95% CI 2.38 to
8.65, p <0.0001) but not <50% (HR 1.31, 95% CI 0.65 to 2.62, p = 0.45), with significant
interactions. Furthermore, patients with AF recurrences within 1 year had a greater
HF hospitalization risk after 1 year (1.61% vs 0.79%, log-rank p = 0.019). In conclusion,
AF recurrence after RFCA was independently associated with HF hospitalizations.
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Article info
Publication history
Published online: December 14, 2022
Received in revised form:
October 11,
2022
Received:
July 20,
2022
Footnotes
This study was supported by the Research Institute for Production Development in Kyoto, Japan.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
