Moderate/severe biatrial dilation predicts adverse events after ablation in atrial fibrillation with heart failure.

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To retrospectively compare the long-term outcomes following atrial fibrillation (AF) ablation between heart failure (HF) with preserved ejection fraction (EF) (HFpEF) and reduced/mildly reduced EF (HFr-mrEF) patients, and to identify novel predictors of adverse clinical events. In total, 1402 AF patients with HF who underwent successful ablation were consecutively enrolled. Adverse clinical events including all-cause death, HF hospitalization, and stroke were followed up. Cox proportional hazards models were used to assess the associations between clinical factors and events. Kaplan-Meier analysis was performed to estimate the cumulative incidences of these events. A receiver operating characteristic curve was used to test the ability of these predictors. During a follow-up period of 42±15months, 265 (18.9%) patients experienced adverse clinical events after ablation. The cumulative incidence of adverse clinical events was significantly higher in HFr-mrEF than in HFpEF (25.4% vs. 15.7%, P<0.001), the similar tendency was observed on all-cause death (10.5% vs. 6.5%, P=0.011) and HF hospitalization (17.2% vs. 10.1%, P<0.001). After multivariate adjustment, non-paroxysmal AF [hazard ratio (HR) 1.922, 95% confidence interval (CI) 1.130-3.268, P=0.016], LAD≥45mm (HR 2.197, 95% CI 1.206-4.003, P<0.001), LVEF (HR 0.959, 95% CI 0.946-0.981, P<0.001), and RAD ≥ 45mm (HR 2.044, 95% CI 1.362-3.238, P<0.001) remained the independent predictors for developing adverse clinical events. A predictive model performed with non-paroxysmal AF, LAD≥45mm and RAD≥45mm yielded an area under curve of 0.728 (95% CI 0.696-0.760, P<0.001). AF patients with HFpEF had better long-term outcomes than those with HFr-mrEF, and moderate/severe biatrial dilation could predict adverse clinical events following catheter ablation in AF and HF patients.