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.