Outcomes for acute decompensated heart failure (ADHF) in the presence of atrial fibrillation (AF) have historically been unfavorable. The current investigation sought to determine whether catheter ablation (CA) could improve clinical outcomes in individuals with both conditions. A retrospective review was conducted of all ADHF cases involving AF that required admission to our hospital during 2007 through 2017. The analysis ultimately incorporated 472 patients, who were monitored for a mean duration of 32.8 ± 32.9 months. Event-free survival (defined as freedom from cardiovascular death or heart failure hospitalization) stood at 61.4% after five years and declined to 42.7% by ten years. Patients who suffered events differed from those who did not in several respects: they tended to be older (72.1 ± 11.0 years versus 68.8 ± 13.4 years, P = 0.008) and were more likely to fall into Clinical Scenario 3 (24% versus 12%, P = 0.001). In addition, the event group showed markedly lower maintenance of sinus rhythm (17% versus 31%, P < 0.001) and underwent CA far less frequently (9% versus 21%, P = 0.003). Those treated with CA consistently achieved better event-free survival than their untreated counterparts, with the benefit persisting after adjustment for baseline differences through matching (log-rank test: P < 0.001). The emergence of AF at initial presentation of ADHF was associated with a generally unfavorable long-term prognosis. However, CA offered encouraging potential to improve prognosis in appropriately selected patients from this challenging population.
