Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation

Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. We retrospectively investigated patients who underwen...

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Published in:Journal of cardiovascular electrophysiology 2024-11
Main Authors: Marek, Josef, Stojadinović, Predrag, Wichterle, Dan, Peichl, Petr, Hašková, Jana, Borišincová, Eva, Štiavnický, Petr, Čihák, Robert, Šramko, Marek, Kautzner, Josef
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container_title Journal of cardiovascular electrophysiology
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creator Marek, Josef
Stojadinović, Predrag
Wichterle, Dan
Peichl, Petr
Hašková, Jana
Borišincová, Eva
Štiavnický, Petr
Čihák, Robert
Šramko, Marek
Kautzner, Josef
description Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p 
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Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p &lt; 0.001). Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p &lt; 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m , p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p &gt; 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p &lt; 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. 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Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p &lt; 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m , p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p &gt; 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p &lt; 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. 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Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p &lt; 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m , p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p &gt; 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p &lt; 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. 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title Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation
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