Moderate/severe biatrial dilation predicts adverse events after ablation in atrial fibrillation with heart failure

Abstract Aims To retrospectively compare the long‐term outcomes following atrial fibrillation (AF) ablation between heart failure (HF) with preserved ejection fraction (EF) (HFpEF) and reduced/mildly reduced EF (HFr‐mrEF) patients, and to identify novel predictors of adverse clinical events. Methods In total, 1402 AF patients with HF who underwent successful ablation were consecutively enrolled. Adverse clinical events including all‐cause death, HF hospitalization, and stroke were followed up. Cox proportional hazards models were used to assess the associations between clinical factors and events. Kaplan–Meier analysis was performed to estimate the cumulative incidences of these events. A receiver operating characteristic curve was used to test the ability of these predictors. Results During a follow‐up period of 42 ± 15 months, 265 (18.9%) patients experienced adverse clinical events after ablation. The cumulative incidence of adverse clinical events was significantly higher in HFr‐mrEF than in HFpEF (25.4% vs. 15.7%, P < 0.001), the similar tendency was observed on all‐cause death (10.5% vs. 6.5%, P = 0.011) and HF hospitalization (17.2% vs. 10.1%, P < 0.001). After multivariate adjustment, non‐paroxysmal AF [hazard ratio (HR) 1.922, 95% confidence interval (CI) 1.130–3.268, P = 0.016], LAD ≥ 45 mm (HR 2.197, 95% CI 1.206–4.003, P < 0.001), LVEF (HR 0.959, 95% CI 0.946–0.981, P < 0.001), and RAD ≥ 45 mm (HR 2.044, 95% CI 1.362–3.238, P < 0.001) remained the independent predictors for developing adverse clinical events. A predictive model performed with non‐paroxysmal AF, LAD ≥ 45 mm and RAD ≥ 45 mm yielded an area under curve of 0.728 (95% CI 0.696–0.760, P < 0.001). Conclusions AF patients with HFpEF had better long‐term outcomes than those with HFr‐mrEF, and moderate/severe biatrial dilation could predict adverse clinical events following catheter ablation in AF and HF patients.