AF-free HF
Of the 20 patients that had a HF event, 9 did not have a recurrence of
AF. All baseline demographics and procedural details were compared
between those that had an AF-free HF event and those that did not. A
univariate analysis revealed patients with chronic kidney disease (CKD),
higher LAP, and higher RAP post-procedure were more likely to have an
AF-free HF event (Table 4 ). Here, because of the small sample
size, values were not normally distributed. Median (interquartile range)
LAP and RAP for those without a HF event compared to those with a HF
event were 9.5 (7, 13) v 14 (9, 15.5) and 5 (4, 7.8) v 9 (5.5, 11) mmHg,
respectively. Unlike patients with a HF event and recurrent AF, the
presence of mitral valve disease, use of a loop diuretic, persistent AF
and lack of class III antiarrhythmic did not correlate to the endpoint
of AF-free HF. A receiver-operatory curve was performed and identified
the sum of the LAP and RAP as a discriminator of AF-free HF events
(Figure 3 ). Specifically, those patients with a LAP and RAP sum
greater than or equal to 20 were more likely to have an AF-free HF
event.
DISCUSSION
Ablation has proven to be a safe and effective treatment option for
patients with AF. Over the past several years, studies have revealed
that the incidence of HF post-ablation is much higher than initially
described. Our retrospective study only found a 3.3% incidence of early
postop HF. Those most susceptible were, unsurprisingly, those with a
known diagnosis of HF, and those who received more intraprocedural fluid
and had longer cases. These variables were codependent, as the
multivariable model showed no independent associations with HF. However,
in our prospective, single center study with perfect 30 day follow up,
we confirmed other recent data by reporting a 20% incidence of HF
post-ablation. Incident HF may be related to recurrent AF, baseline loop
diuretic use and elevated atrial pressures, especially in those with
moderate-severe mitral valve disease and a history of persistent AF. The
rate difference compared to the retrospective cohort confirms a large
underascertainment from retrospective studies, and the importance of
prospective data collection in this population.