Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

Introduction Catheter ablation (CA) has been increasingly used to treat atrial fibrillation (AF) in patients with heart failure (HF), however, its safety at the population‐level has not yet been evaluated. To assess the safety of CA in AF‐HF patients, the frequency and potential risk factors for adverse events (AEs) within 30 days post‐CA were determined. Methods A population‐based cohort of AF‐HF patients who underwent CA in Quebec, Canada (2000‐2017) was constructed using administrative databases. Major AEs included all‐cause mortality, cerebrovascular accident (CVA), pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. Univariate logistic regression models were employed to assess potential risk factors for major AEs. Results Of 700 AF‐HF patients who underwent CA (median age 64.5 years [interquartile range, IQR, 56.2‐71.0], 22.0% female, and median CHA2DS2‐Vasc 3 [IQR, 2‐4]), 14 (2.0%) patients developed 16 major AEs within 30 days of CA. Hemorrhage/hematoma was the most frequent major AE (four patients; 0.6%) followed by all‐cause mortality, CVA/TIA, PERD, and vascular AEs (three patients each; 0.4%). Coronary artery disease (odds ratio [OR], 3.9 [95% confidence interval, CI, 1.2‐12.3]) and age ≥65 years (OR, 3.1 [95% CI, 1.1‐9.8]) were identified predictors for the composite outcome of major AEs. More than half of the patients (57.2%) underwent a second CA within a median of 0.8 (IQR, 0.2‐2.2) years from the date of first CA. Conclusion CA performed in the AF‐HF population portends a relatively low incidence of major AEs. A larger study is required to determine whether certain patient factors are independently associated with a higher risk of post‐CA AEs.