Incidence and Predictors of New-Onset Heart Failure After Catheter Ablation for Atrial Fibrillation in Patients With a Preserved Ejection Fraction.

Background: The incidence and predictors of new-onset heart failure (HF) after catheter ablation for atrial fibrillation (AF) remain unclear, particularly in patients with preserved left ventricular ejection fraction (EF ≥50%) and no prior HF. Methods and Results: We retrospectively analyzed 480 consecutive patients with EF ≥50% and no prior HF who underwent initial AF ablation. Recurrent atrial tachyarrhythmias (ATs) and new-onset HF were assessed during follow up. Landmark analyses at 3 and 12 months after the first procedure were performed to evaluate predictors of new-onset HF and the association between recurrence of early ATs and subsequent HF. Additionally, recurrence of ATs after the final ablation was examined as a time-dependent covariate using a Cox proportional hazards model. During a median follow up of 70 months (interquartile range 60-84 months), 18 (3.75%) patients developed new-onset HF. Age >75 years was the only consistent independent predictor in both landmark analyses. Early recurrence of ATs within 3 or 12 months was not associated with HF development. However, recurrence of ATs after the final procedure was independently associated with new-onset HF in a time-dependent analysis (hazard ratio 4.028; 95% confidence interval 1.564-10.378; P=0.004). Conclusions: In patients with preserved EF and no prior HF, new-onset HF after AF ablation was uncommon but clinically relevant. Durable rhythm control may be important to reduce HF risk.