https://doi.org/10.1007/s00392-025-02625-4
1Asklepios Klinik St. Georg Interventionelle Kardiologie und Elektrophysiologie Hamburg, Deutschland; 2Asklepios Klinik St. Georg Kardiologie / Asklepios proresearch Hamburg, Deutschland
Background: Catheter ablation (CA) for atrial fibrillation (AF) has emerged as a therapeutic option for patients with heart failure (HF), a population with a high prevalence of AF. Despite proven mortality reduction for CA in these patients’ clear recommendations on timing and in hospital data are sparse.
Aim: This study aims to identify potential predictors that influence the timing of catheter ablation (CA) for atrial fibrillation (AF) in patients with HF within a large cohort. Additionally, in-hospital outcomes were compared between AF+HF patients who underwent CA and those who received conservative treatment.
Methods: Consecutive patients hospitalized with HF and concomitant AF between 2017 and 2024 at our center were retrospectively analyzed. Admissions for HF associated with acute ST-segment elevation myocardial infarction (STEMI) were excluded. Patient demographics, CA procedures for AF, and in-hospital outcomes were identified using ICD-10 and OPS codes. Patients were categorized based on whether they underwent CA for AF or received conservative treatment during the same hospital stay.
Results: A total of 10,566 patients were analyzed, with a median age of 77 years (IQR: 69-83) and 60% male. The median left ventricular ejection fraction (LVEF) was 43% (IQR: 32-53), and median NT-pro-BNP levels were 4,032 pg/mL (IQR: 1,785-9,118). Of these, 1,381 patients (14%) underwent catheter ablation (CA) for atrial fibrillation, while 8,566 patients (86%) received conservative treatment, including 22% with electrical cardioversion, 27% treated with amiodarone, 3% with Class I antiarrhythmic drugs (AADs), and 48% with beta-blockers. Patients who underwent CA had lower NT-proBNP levels (median 2,450 pg/mL [IQR: 1,048-5,284] vs. 4,215 pg/mL [IQR: 1,883-9,632], p<0.001) and a more preserved LVEF (median 43% [IQR: 32-53] vs. 39% [IQR: 31-50], p=0.026). The timing of CA was influenced by age and gender, with women undergoing CA 23% later than men of the same age. Patients presenting in NYHA class III and IV were less likely to undergo CA during hospitalisation. Overall, CA was associated with a significant reduction in hospital stay duration (median of 3 days [IQR: 2-8] vs. 10 days [IQR: 6-18], p<0.001) and lower rates of ICU admission (5.1% vs. 24%, p<0.001) compared to conservative treatment.
Conclusion: Catheter ablation for patients admitted with HF and AF is associated with significant reductions in hospital stay duration and ICU admission rates. Lower NT-proBNP levels and more preserved left ventricular ejection fraction (LVEF) appear to prompt the decision for CA during hospitalization. However, female patients tend to receive CA later than their male counterparts. Despite the demonstrated benefits of CA for AF in patients with severe HF, this large cohort highlights that a substantial proportion of patients continue to be managed with conservative treatments.