Atrial fibrillation (AF) ablation was independently associated with a lower risk of death and hospitalisation for heart failure (HF) when analysed in a real-world setting with unselected AF patients with HF seen in hospitals. These findings are consistent with what was previously observed in recent trials with lower numbers of highly selected patients.
Catheter ablation is a validated therapy for patients with symptomatic AF in order to prevent recurrences of the condition. Data from the CASTLE-AF study showed that ablation for AF in patients with HF was associated with a lower rate of death from any cause or hospitalisation for worsening HF than medical therapy. However, this was done in a highly selected environment. French researchers aimed to compare the incidence of death from any cause or hospitalisation for worsening HF in AF patients with HF after AF catheter ablation vs those not treated with AF ablation at a nationwide level in centres possibly less well experienced.
Prof. Fauchier (University of Tours, France) and colleagues assessed data from the French administrative hospital-discharge database (covering 98% of 67 million people), consisting of 252,395 patients with AF and HF data in France between 2010 and 2018. Of those, 1,384 patients (0,5%) were treated with AF ablation. During follow-up (537 days), there were 57,884 hospitalisations with a primary diagnosis of HF, and 96,467 deaths were recorded. The incidence of death was significantly lower in patients with AF ablation than in those with no ablation (3.4% vs 26.3% per person-year respectively, HR 0.17). The incidence of hospitalisation for HF was also significantly lower in patients with AF ablation than in those with no ablation (9.9% vs 33.4% person per year respectively, HR 0.29). These associations were confirmed in a multivariable analysis after adjustment on age and other comorbidities. For all-cause death, HR was 0.29 and f HR 0.24 for HF. These findings confirm the CASTLE-AF outcomes in a real-world setting.
1. Fauchier L. Are the results of the CASTLE-AF trial reproducible in the real life? Clinical outcomes after catheter ablation for atrial fibrillation with heart failure in a nationwide cohort study. FP Number 486. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.
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