Catheter ablation for persistent atrial fibrillation after acute decompensated heart failure Attack: Earlier is Better?

Background: Acute decompensated heart failure (ADHF) is often accompanied by persistent atrial fibrillation (AF). However, the optimal timing for RFCA in patients with persistent AF and ADHF is still uncertain. Objectives: The aim of this observational cohort study is to investigate the safety and efficacy of early RFCA in patients with persistent AF after ADHF attack. Methods: Patients with persistent AF and ADHF who underwent early RFCA as soon as the ADHF symptoms were initially controlled (Early group, n = 63) and those who received elective procedures after a transitional period (Elective group, n = 67) were investigated. After 1:1 propensity score matching, 50 matched pairs were analyzed. Results: The overall procedural complication rates were similar (Early group: 6.0 %, n = 3; Elective group: 6.0 %, n = 3; P = 1.000). Patients in the early group had significantly less HF rehospitalization than the elective group during the 1-year post-procedure follow-up period (Mantel-Cox test: P = 0.036; HR: 0.369; 95 %CI: 0.145-0.938), though AF recurrence showed no difference (Mantel-Cox test: P = 0.645; HR: 1.204; 95 %CI: 0.547-2.648). A 90-day rehospitalization rate was significantly higher in the transitional period in the elective group, compared with patients who already received early RFCA (Elective group: 13, 26.0 %; Early group: 2, 4.0 %; P = 0.002). Conclusions: Early RFCA therapy for persistent AF after ADHF attack was safe and effective. Patients who received early RFCA therapy had significantly less HF rehospitalization in the 1-year post-procedure follow-up period. On the other hand, the elective procedure was accompanied by a higher risk of HF rehospitalization during the waiting period.