AB-452643-2 EARLY PULMONARY VEIN ISOLATION IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION

Abstract

Atrial fibrillation (AF) and heart failure (HF) often coexist leading to worse outcomes compared to AF or HF alone. According to the current guidelines, pulmonary vein isolation (PVI) as first-line therapy should be considered, however, the optimal timing of the procedure is still unknown. We aimed to investigate the effect of early PVI on all-cause mortality and AF recurrence in patients with HF. We analyzed the data of 162 patients with symptomatic paroxysmal or persistent AF and HF with LVEF < 50% who underwent PVI between 2010 and 2022. The patients’ medical history, laboratory results, echocardiographic and periprocedural parameters were collected in a structured registry. Early PVI was defined as catheter ablation performed within 12 months of AF diagnosis. The median follow-up was 59.7 months, the minimum follow-up was 12 months. Our primary endpoints were AF recurrence after a 3-months blanking period and all-cause mortality at any time during follow-up. Among the 162 patients, 77 (47.5%) experienced AF recurrence and 39 (24.1%) died during follow-up. The median age was 63.2 years. The median LVEF was 40% for early PVI and 37% for deferred PVI. Out of the 63 patients who underwent early PVI, 33 (52%) were taking amiodarone. Patients who underwent early PVI had longer freedom from recurrence compared to late PVI (median 833 days vs. median 696 days, respectively, p=0.02). Early PVI was a negative predictor of AF recurrence (HR: 0.58 [0.32-0.94], p=0.03). Early ablation had no beneficial impact on mortality (p=0.68). However, among those who experienced AF recurrence, repeat ablation was associated with better survival with univariate Cox regression (p=0.01). Furthermore, in multivariate model, repeat ablation was shown to be protective of mortality (HR: 0.312 [0.113-0.865], p=0.03) in the whole cohort. Our study shows that early rhythm control therapy with catheter ablation is more successful compared to deferred PVI in patients with AF and HF. A redo-PVI was associated with better survival, thus a repeat ablation should be considered in case of arrhythmia recurrence in patients with AF and HF to reduce mortality.