Abstract 128: Catheter-based Ablation May Improve Survival in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction and Atrial Fibrillation or Flutter with Rapid Ventricular Response

Background: There is no current evidence regarding safety and efficacy of various rhythm control strategies such as Amiodarone, electrical cardioversion (DCCV), catheter based ablation and other anti-arrhythmic drugs (AAD) for acute control of rapid ventricular response (RVR) in hospitalized patients with atrial fibrillation or flutter (AF/AFL) and acute decompensated heart failure with reduced ejection fraction (ADHFrEF). Methods: Single center retrospective study from our registry of hospitalized patients with ADHFrEF and rapid AF/AFL over a 5-year period Results: We included 52 patients with ADHFrEF and rapid AF/AFL (mean age, 64.3±13.9 years; 39 (75%) males; mean left ventricular EF [%], 29.4±8.1; median follow up duration [months], 13 [interquartile range, 5.3-19]): 30 (57.7%) received amiodarone, 19 (36.5%) received DCCV, 10 (19.2%) received catheter ablation and 1 (1.9%) received other AAD. Patients who were treated with catheter ablation had significantly higher rates of survival to median follow up and to hospital discharge compared to those who were not treated with ablation. There were no significant differences in symptoms control, major bleeding event, systemic embolism, worsening HF, procedure related complications, and length of hospital stay between patients treated with and without amiodarone, DCCV and catheter ablation (Table 1). New onset AF/AFL, new HF, left ventricular EF, NYHA functional class, and loading with AAD did not predict response to DCCV (P = 0.22-0.87) (Table 2). Conclusion: Acute control of rapid AF/AFL in hospitalized patients with ADHFrEF using catheter ablation significantly improved survival. Catheter-based ablation may be a safe and efficacious treatment option for these patients.