Abstract 4128369: Inpatient Mortality After Catheter Ablation for Atrial Fibrillation Among Heart Failure Patients: A 6-Year Nationwide Analysis

Background: Significant advancements have been made in the safety of catheter ablation for atrial fibrillation (AF) over the past decade. However, large-scale data regarding inpatient mortality among heart failure (HF) patients (HF with reduced ejection fraction [HFrEF] and HF with preserved ejection fraction [HFpEF]) who undergo AF ablation are lacking. Aim: To compare mortality rates and trends between patients with HF (HF group) and without HF (non-HF group) following AF catheter ablation. Methods: The National Inpatient Sample was utilized from January 2015 to December 2020 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was in-hospital mortality for patients with and without HF undergoing ablation for AF, and the secondary outcome was mortality in patients with HFrEF compared with those with HFpEF. Results: We evaluated 142,860 patients hospitalized for AF who underwent catheter ablation. Of these, 42.2% (n=60,334) had HF (29% HFrEF; 71% HFpEF). The HF cohort was older (69.7 years) and predominantly male (61.3%) compared with non-HF (66.7 years, P<.001 and 55.7%, P<0.00, respectively). Overall mortality in the HF group was 3-fold higher (1.6% vs 0.5%, P<.001). Within the HF group, mortality in HFrEF was 1.8 times higher than in HFpEF (2.4% vs 1.3%, P<.001). Over the study period, mortality rates declined in the HF cohort (Fig. 1A), both in HFrEF (from 4.1% to 2.2%, P=.012) and HFpEF (from 2.7% to 1.3%, P=.006) (Fig 1B). In non-HF, mortality rates remained relatively unchanged during the study period (from 1.4% to 1.6%, P=.344). Conclusion: Overall mortality following AF ablation is relatively low. Despite the higher mortality observed in patients with HF, the overall rate declined in both HFrEF and HFpEF over the study period. This reduction in mortality may reflect improvements in HF treatment and ablation techniques. Further research is needed to elaborate on the factors contributing to these trends and to develop targeted interventions to reduce mortality in this high-risk population.