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

Chinmay Jani, MD; Shilpkumar Arora, MD, MPH; Zachary Zuzek, MD; Rahul Jaswaney, MD; Samarthkumar Thakkar, MD; Harsh P. Patel, MD; Sopan Lahewala, MD; Nirav Arora, MS; Richard Josephson, MD; Abhishek Deshmukh, MD; Juan Viles-Gonzalez, MD; Mohammed Najeeb Osman, MD, FHRS; Jayakumar Sahadevan, MD; Brian D. Hoit, MD; Judith A. Mackall, MD, FHRS

Heart Rhythm O2 (Feb 2021)

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

Chinmay Jani, MD,
Shilpkumar Arora, MD, MPH,
Zachary Zuzek, MD,
Rahul Jaswaney, MD,
Samarthkumar Thakkar, MD,
Harsh P. Patel, MD,
Sopan Lahewala, MD,
Nirav Arora, MS,
Richard Josephson, MD,
Abhishek Deshmukh, MD,
Juan Viles-Gonzalez, MD,
Mohammed Najeeb Osman, MD, FHRS,
Jayakumar Sahadevan, MD,
Brian D. Hoit, MD,
Judith A. Mackall, MD, FHRS

Affiliations

Chinmay Jani, MD: Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts
Shilpkumar Arora, MD, MPH: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Zachary Zuzek, MD: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Rahul Jaswaney, MD: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Samarthkumar Thakkar, MD: Rochester General Hospital, Rochester, New York
Harsh P. Patel, MD: Louis A. Weiss Memorial Hospital, Chicago, Illinois
Sopan Lahewala, MD: University of Connecticut, Hartford, Connecticut
Nirav Arora, MS: Lamar University, Beaumont, Texas
Richard Josephson, MD: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Abhishek Deshmukh, MD: Mayo Clinic, Rochester, Minnesota
Juan Viles-Gonzalez, MD: Miami Cardiac and Vascular Institute/ Baptist Health South Florida, Miami, Florida
Mohammed Najeeb Osman, MD, FHRS: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Jayakumar Sahadevan, MD: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Brian D. Hoit, MD: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
Judith A. Mackall, MD, FHRS: Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio; Address reprint requests and correspondence: Dr Judith A. Mackall, Division of Cardiology, Department of Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5038.

Journal volume & issue: Vol. 2, no. 1
pp. 53 – 63

Abstract

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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, P < .001). HF readmission (HR 0.73, 95% CI 0.61–0.89, P = .001), all-cause mortality (HR 0.62, 95% CI 0.46–0.85, P = .003), and AF readmission (HR 0.63, 95% CI 0.48–0.82, P = .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, P = .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.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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