Impact of catheter ablation in patients with atrial flutter and concurrent heart failure

Authors

Chinmay Jani, Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts.
Shilpkumar Arora, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Zachary Zuzek, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Rahul Jaswaney, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Samarthkumar Thakkar, Rochester Regional HealthFollow
Harsh P. Patel, Louis A. Weiss Memorial Hospital, Chicago, Illinois.
Sopan Lahewala, University of Connecticut, Hartford, Connecticut.
Nirav Arora, Lamar University, Beaumont, Texas.
Richard Josephson, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Abhishek Deshmukh, Mayo Clinic, Rochester, Minnesota.
Juan Viles-Gonzalez, Miami Cardiac and Vascular Institute/ Baptist Health South Florida, Miami, Florida.
Mohammed Najeeb Osman, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Jayakumar Sahadevan, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Brian D. Hoit, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Judith A. Mackall, Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.

Department

Medicine

Document Type

Article

Publication Title

Heart Rhythm O2

Abstract

Background: No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF). Objectives: To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF. Methods: This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016-17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios. Results: Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61-0.85, < .001). HF readmission (HR 0.73, 95% CI 0.61-0.89, = .001), all-cause mortality (HR 0.62, 95% CI 0.46-0.85, = .003), and AF readmission (HR 0.63, 95% CI 0.48-0.82, = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63-1.01, = .065). Conclusion: In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.

First Page

53

Last Page

63

DOI

10.1016/j.hroo.2020.11.005

Volume

2

Issue

1

Publication Date

2-2021

PubMed ID

34113905

Recommended Citation

Jani, C., Arora, S., Zuzek, Z., Jaswaney, R., Thakkar, S., Patel, H. P., Lahewala, S., Arora, N., Josephson, R., Deshmukh, A., Viles-Gonzalez, J., Osman, M. N., Sahadevan, J., Hoit, B. D., & Mackall, J. A. (2021). Impact of catheter ablation in patients with atrial flutter and concurrent heart failure. Heart Rhythm O2, 2 (1), 53-63. https://doi.org/10.1016/j.hroo.2020.11.005