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