B-po03-114 atrial fibrillation and heart failure with preserved versus reduced ejection fraction: outcomes after catheter ablation

Catheter ablation of atrial fibrillation (AF) has been recognized as an important treatment for patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Limited real-world data exist on early outcomes in patients with heart failure with preserved ejection fraction (HFpEF) undergoing AF ablation. To examine and compare rates of index procedural complications and 30-day readmissions after AF ablation in patients with HFpEF and HFrEF. Using the Nationwide Readmissions Database (NRD), we examined 50,299 admissions of adults with heart failure undergoing AF ablation between 2010 and 2014. Using ICD-9-CM codes, we identified procedural complications and causes of readmission following AF ablation. From 2010 to 2014, the prevalence of HFpEF increased from 3.05% to 7.35% (P-for-trend <0.001) and the prevalence of HFrEF increased from 3.82% to 7.63% (P-for-trend <0.001) among patients undergoing AF ablation. The mean age of patients with HFpEF, HFrEF and no heart failure undergoing AF ablation were 72.3 (standard error [SE] 0.39), 68.2 (SE 0.39) and 63.4 (SE 0.15), respectively. Procedural complications and mortality occurred in 8.4% and 0.30% of patients with HFpEF, 6.2% and 0.49% of patients with HFrEF and 6.2% and 0.08% of patients without heart failure (P = 0.048 and P < 0.001), respectively. All-cause 30-day readmissions occurred in 18.3% of patients with HFpEF and 20.1% of patients with HFrEF, compared to 9.5% in patients without heart failure (P < 0.001). After adjustment for age, co-morbidities, and hospital factors, HFpEF and HFrEF were independently associated with all-cause 30-day readmissions with OR 1.50 (95% CI: 1.15 - 1.96) and OR 1.49 (95% CI: 1.41 - 1.95), respectively when compared to patients without heart failure. In this nationally representative cohort, the prevalence of both HFpEF and HFrEF increased significantly from 2010-2014 among patients undergoing AF ablation. Both HFpEF and HFrEF were independent predictors of all-cause 30-day readmissions. Multidisciplinary peri-procedural heart failure management may be paramount to reduce readmissions after AF catheter ablation.