Association Between Periprocedural Heart Rate Trend and Postprocedural Worsening Heart Failure in Patients Receiving Catheter Ablation for Atrial Fibrillation

To the Editor:

Worsening heart failure is receiving considerable attention as a concerning periprocedural complication in patients receiving catheter ablation for atrial fibrillation (AF). Using a large-scale dataset, Matsuda et al investigated the association between periprocedural heart rate trend and worsening heart failure following catheter ablation for AF.¹ Several concerns have been raised.

Preprocedural baseline characteristics, particularly the hemodynamics profile, have considerable effects on the development of heart failure following catheter ablation. Do the authors have right heart catheterization data and echocardiography data? These preprocedural data may be more progressed in patients who had post-procedural worsening heart failure.

The optimal heart rate in patients with AF remains uncertain, regardless of the left ventricular ejection fraction level.^2,3 Most participants in the study of Matsuda et al did not have sick sinus rhythm following catheter ablation.¹ Thus, the clinical implication of heart rate trends between pre- and post-procedural ones may be unclear.

According to their findings,¹ do the authors have any therapeutic suggestions to decrease incident heart failure following catheter ablation? For example, preprocedural measurement of left atrial pressure and the periprocedural administration of diuretics, if applicable, may improve clinical outcomes following catheter ablation.

Disclosures

None.

• Naoya Kataoka, MD, PhD
• Teruhiko Imamura, MD, PhD
• Second Department of Internal Medicine, University of Toyama, Toyama, Japan

References

• 1.   Matsuda Y, Masuda M, Sakio T, Asai M, Iida O, Okamoto S, et al. Heart rate decrease after atrial fibrillation catheter ablation predicts decompensated heart failure after the procedure. Circ Rep 2022; 4: 461–468.
• 2.   Li SJ, Sartipy U, Lund LH, Dahlstrom U, Adiels M, Petzold M, et al. Prognostic significance of resting heart rate and use of beta-blockers in atrial fibrillation and sinus rhythm in patients with heart failure and reduced ejection fraction: Findings from the Swedish Heart Failure Registry. Circ Heart Fail 2015; 8: 871–879.
• 3.   Sartipy U, Savarese G, Dahlstrom U, Fu M, Lund LH. Association of heart rate with mortality in sinus rhythm and atrial fibrillation in heart failure with preserved ejection fraction. Eur J Heart Fail 2019; 21: 471–479.