Abstract 15329: Heart Failure is an Adverse Risk Factor for Peri-Procedural Complications in Patients Undergoing Pulmonary Vein Isolation and Ablation for Atrial Fibrillation

Abstract

Introduction: Percutaneous catheter ablation (PCA) for non-valvular atrial fibrillation (AF) is rapidly becoming commonplace for recently diagnosed paroxysmal AF. Heart failure (HF) and AF commonly coexist in patients. Elevated left ventricular and atrial pressures result in progressive left atrial dilation and remodeling which in turn predisposes to the generation of AF. Since many who undergo PCA for AF could have HF, we aimed to assess peri-procedural outcomes in this population. Methods: We utilized the National Inpatient Sample from 2016-2019 to identify 74,205 hospitalized adults who underwent PCA for AF. These hospitalizations were further stratified based on the presence of HF. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Of those who underwent PCA for AF, 33,435 (45%) had HF. In-hospital mortality was higher in those with HF (1.9% vs 1.14%; p=0.0001). Figure 1 shows the Forrest plot for multivariate analysis of peri-procedural complications when adjusted for patient demographics, co-morbidities, and hospital characteristics. When adjusted similarly, patients with HF who underwent PCA for AF had longer length of stay (LOS) by 1.5 days (p<0.001) and had additional hospital costs (HC) of $14,726 (p<0.001). Conclusions: In this study, patients undergoing Percutaneous catheter ablation (PCA) for AF with co-existing acute HF had significantly worse end points in terms of in-hospital mortality, LOS, HC, atrial flutter, AKI, sepsis, pneumonia, endotracheal intubation. One major limitation of our study is the lack of outpatient follow up. Although outcomes are worse in the acute setting of HF, there have been several studies such as CASTLE-AF, outlining that early ablation for AF in HF is associated with positive long-term effects including lower rates of death and hospitalization for HF. Despite unfavorable peri-procedural outcomes of HF in PCA, the long-term benefits should not be overlooked.