Early pulmonary vein isolation in patients with heart failure

Abstract

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are often present simultaneously, leading to worse outcomes compared to the respective morbidity alone. Pulmonary vein isolation (PVI) is the most effective treatment modality and should be considered as first-line therapy, however, the optimal timing of the procedure is still unknown. Purpose We aimed to investigate the effect of early PVI on all-cause mortality and AF recurrence in patients with HF. Methods The data of 334 patients with symptomatic paroxysmal (n=118, 35.5%) or persistent (n=212, 63.5%) AF and HF with LVEF < 50% were analyzed, who underwent PVI using radiofrequency energy between 2010 and 2022. All available medical data of the patients 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 1524.5 [365.0-3939.0] days with a minimum of 365 days. Our primary endpoints were all-cause mortality and AF recurrence following 3-months blanking period. Results During the follow-up of the 334 patients, 164 (49.1%) experienced AF recurrence and 86 (25.8%) patients died. The median age was 64 [56.1-69.9] years. The median LVEF was 40% for early PVI and 38% for deferred PVI (p=0.057). Out of the 139 (41.6%) patients who underwent early PVI, 36 (25.9%) had AF recurrence and 83 (59.7%) were taking amiodarone. Patients who underwent early PVI had longer freedom from recurrence (median 1042.5 [474.8-1921.0] days for early PVI, median 424 [134.5-1153.0] days for deferred PVI). Early PVI predicted lower rate of AF recurrence (HR: 0.29, p<0.0001). Early ablation was not associated with mortality benefit. Among those who experienced AF recurrence, a repeat ablation was associated with better survival (HR: 0.29, p<0.0001). Conclusions Our study shows that early rhythm control therapy with catheter ablation may be more beneficial compared to deferred PVI in patients with AF and HF. A repeat ablation may be considered in case of arrhythmia recurrence in patients with AF and HF to reduce mortality.