Clinical risk factors for decompensated heart failure after atrial fibrillation ablation

Introduction: Although decompensated heart failure (DHF) can complicate catheter ablation of atrial fibrillation (AF), its incidence and risk factors have not been defined. We sought to investigate the incidence and risk factors for DHF in these patients. Methods: In total, 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; females, 346 [34%]; and persistent AF, 513 [51%]) were enrolled. Δheart rate, which was defined as heart rate after ablation minus heart rate before ablation, were calculated. DHF was defined as heart failure requiring medical therapy during post-procedure hospitalization, or re-hospitalization due to heart failure < 90 days after the procedure. DHF was classified into early peri-procedual DHF, which occurring within 2 days after the procedure, and late peri-procedual DHF, which occurring ≥ 3 days after the procedure. Results: The incidence of DHF was 32/1004 (3%) patients. Patients with DHF had a higher prevalence of a past history of symptomatic heart failure (17/32 [53%] versus 154/972 [16%], P < 0.01) and lower Δheart rate after the procedure than those without (−16 ± 28 versus 2 ± 21 beats/min, P < 0.01). On multivariate analysis, lower Δheart rate was a significant independent predictor of early peri-procedual DHF, while early recurrence of AF was a significant independent predictor of late peri-procedual DHF. Conclusion: In patients with AF, lower Δheart rate was an independent predictor of early peri-procedual DHF, and early recurrence of AF was an independent predictor of late peri-procedual DHF.