Prospective Study
For the prospective study, we enrolled 100 consecutive patients
undergoing AF ablation. No patient was excluded or lost to follow-up. A
HF episode occurred in 20% of the patients within 30 days. Fourteen
patients out of the 20 (70%) had a HF episode captured by the
prespecified phone survey administered at 30 days. Three patients (15%)
had a HF episode captured via electronic medical record review and 3
patients (15%) had a HF episode captured by both methods (Figure
1).
Baseline demographics and procedural details are displayed inTable 1 . The average age was 64.5 ± 10 and 63% of the subjects
were males. The average ejection fraction was 50 ± 10%, with HF
prevalence of 17%, a group whose mean EF was 46 ± 11%. Baseline
comorbidities and procedural characteristics were similar between those
with or without early incident HF with few exceptions. Patients that had
a HF episode had a higher incidence of moderate to severe mitral valve
disease (20% vs 4%; p = 0.01). They were also more likely to have
persistent AF (70% v 41%; p = 0.02), prescribed a loop diuretic (40%
v 17.5%; p = 0.03), have a higher LAP post-ablation (12.6 v 10.2 mmHg;
p = 0.04), and recurrence of AF within 30 days (55% v 14%; p = 0.01).
Patients that did not have a HF episode were more likely to be taking
class III antiarrhythmic medications preoperatively (44% v 15%; p =
0.018). Additionally, those who were taking antiarrhythmics after
ablation had a lower incidence of HF (22.5% v 0%; p = 0.019). There
was no difference in use of beta blocker, calcium channel blockers or
class I antiarrhythmic medication between the two groups. Most patients
had class I and class III antiarrhythmics held after ablation (95% and
72% respectively) though class II and IV antiarrhythmics remained at
pre procedure doses.