Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction

• Authors: Rajkumar Doshi, University of Nevada, Reno; Ashish Kumar, St. John’s Medical College Hospital; Mariam Shariff, St. John’s Medical College Hospital; Devnina Adalja, GMERS Gotri Medical College; Krunalkumar Patel, St. Mary Medical Center; Kirtenkumar Patel, North Shore University Hospital; Rupak Desai, Atlanta VA Medical Center; Nageshwara Gullapalli, University of Nevada, Reno; Saraschandra Vallabhajosyula, Emory University
• Journal Title: Journal of Arrhythmia
• Volume: Volume 37, Number 1
• Publisher: Wiley | 2021-02-01, Pages 60-69
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1002/joa3.12451
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: HFrEF; atrial fibrillation; catheter ablation; surgical ablation

Abstract

Background: There is a lack of research comparing procedural outcomes of surgical ablation (SA) and catheter ablation (CA) among patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The main objective was to compare the short-term procedural outcomes of SA and CA in patients with HFrEF. Methods: We used the national inpatient sample to identify hospitalizations over 18 years with HFrEF hospitalization and AF, and undergoing SA and CA from 2016 to 2017. Furthermore, the clinical outcomes of SA vs CA in AF stratified as nonparoxysmal and paroxysmal were analyzed. Results: A total of 1,770 HFrEF hospitalizations with AF who underwent SA and 1,620 HFrEF hospitalizations with AF who underwent CA were included in the analysis. Hospitalizations with CA had higher baseline comorbidities. The in-hospital mortality among HFrEF with AF undergoing SA as compared with CA was similar (2.8% vs 1.9%, respectively, adjusted P-value 0.09). Hospitalizations with SA had a significantly longer length of hospital stay, a higher percentage of postprocedural, and cardiac complications. In HFrEF hospitalizations with nonparoxysmal AF, SA as compared with CA was associated with a higher percentage of in-hospital mortality (2.4% vs 1%, adjusted P-value <.05), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. Conclusion: CA is associated with lower in-hospital adverse procedural outcomes as compared with SA among HFrEF hospitalizations with AF. Further research with freedom from AF as one of the outcome is needed between two groups for HFrEF.