(B-176) Catheter ablation versus antiarrhythmic drugs for treatment of atrial fibrillation in patients with concomitant heart failure with preserved ejection fraction (HFpEF)

Background: Atrial fibrillation is the most common arrhythmia among adults in the United States (US). AF often coexists with heart failure (HF). About half of patients with HF have preserved ejection fraction (HFpEF). It has been suggested that AF is both a consequence and a precipitating factor of HFpEF deterioration. Catheter ablation (CA) and anti-arrhythmic drugs (AADs) are common treatment modalities for AF.

Objectives: To compare clinical outcomes among AF patients with concomitant HFpEF treated with CA versus AADs.

Methods: A retrospective sample of adult HF patients with left ventricular ejection fraction (LVEF) ≥ 50% and a diagnosis of AF was studied using the Optum PanTher Electronic Health Record (EHR) database. Patients included in this study were required to have at least one AAD prescription between Jan 2014 and Mar 2020. Patients were classified into CA or AAD groups based on their subsequent treatment for AF in the following two years after the initial AAD. Primary outcome of this study was a composite of AF/atrial flutter (AFL)/atrial tachycardia-related inpatient admissions and electrical cardioversions in the 57-730 days post-index treatment period (with the first 8 weeks considered as a blanking period). Secondary outcome including HF-related inpatient or emergency room admissions was also assessed. The inverse probability of treatment weighting (IPTW) propensity score method was applied for covariate (including demographic and clinical characteristics) balancing between the two cohorts. Cox regression analyses were performed to compare outcomes among the weighted cohorts.

Results: There were 562 CA and 1,471 AAD patients in the final sample. After applying IPTW, the two cohorts were well balanced on study covariates. A significantly lower rate of primary composite outcome was observed among patients in the CA cohort versus those in the AAD cohort (14.8% vs. 27.4%, log-rank p-test < 0.001). Cox regression model indicated a 41% lower risk of atrial arrhythmia related admission and cardioversion among patients undergoing CA versus those prescribed AADs (Hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.78) in the 57-730 days post-index treatment period. No significant difference in HF-related admissions was found in the 57-730 follow-up period between the two groups (8.7% vs. 14.4%, log-rank p-test=0.078; HR:0.71, 95% CI 0.47-1.09).

Conclusions: Patients with AF and concomitant HFpEF treated with CA had a significantly lower risk of AF/AFL/atrial tachycardia related inpatient admissions and electrical cardioversions as compared to those treated with AADs.