DHF
DHF occurred in 32/1004 (3%) cases. Ten (31%) cases developed early
recurrence of AF before DHF. For management of early recurrence of AF,
antiarrhythmic agents were used in 8 cases and electrical cardioversion
were performed in 3 cases. A representative case of DHF is shown in
Figure 1. The time course and heart rate from the procedure to DHF are
shown in Figure 2, and the details of patients with DHF are shown in
Supplementary Table 2.
There were different etiologies of heart failure. Patients with late
peri-procedural DHF had a higher prevalence of valvular heart disease
than those with early peri-procedural DHF (4 [40%] versus 2
[9%], P = 0.04). There was no difference in other presumed
etiologies of heart failure, clinical scenarios, Nohria-Stevenson
classification, or management of DHF between early peri-procedural DHF
and late peri-procedural DHF.
Predictors of overall DHF are shown in Supplementary Table 3. Lower
Δheart rate after the procedure and early recurrence of AF were
independent predictors of DHF on multivariate analysis.
Early peri-procedural DHF occurred in 22 (2%) patients. Patients with
early peri-procedural DHF had a higher prevalence of persistent AF, past
history of symptomatic heart failure, diuretic usage, elevated BNP or
N-terminal pro-BNP, and LVAs than those without early peri-procedural
DHF. In addition, patients with early peri-procedural DHF had a higher
New York Heart Association class, higher left atrial diameter, lower
left ventricular ejection fraction, and lower Δheart rate than those
without early peri-procedural DHF. Lower Δheart rate was also an
independent predictor of early peri-procedural DHF in multivariate
analysis (Table 2). Four (18%) patients needed intensive care; however,
no mechanical ventilation with endotracheal intubation for respiratory
failure was needed. Two (9%) patients needed temporary cardiac pacing
for bradycardia. Duration of hospitalization after early peri-procedural
DHF was 3 (1–9) days, and all patients were discharged from the
hospital. Median New York Heart Association class at discharge was 1
(range, 1–1).
Late peri-procedural DHF occurred in 10 (1%) of patients. Patients with
late HF had a higher prevalence of early recurrence of AF, past history
of symptomatic heart failure, diuretics usage, and LVAs than those
without late peri-procedural DHF. In addition, patients with late
peri-procedural DHF had a higher New York Heart Association class,
higher CHA2DS2-VASc score, and lower
left ventricular ejection fraction than those without late
peri-procedural DHF. Early recurrence of AF was also an independent
predictor of late peri-procedural DHF in multivariate analysis (Table
3). Two (20%) patients needed intensive care; however, no mechanical
ventilation with endotracheal intubation or temporary cardiac pacing was
needed. Duration of hospitalization after late peri-procedural DHF was 8
(2–27) days. One patient died due to progression of dilated
cardiomyopathy; the other patients were discharged from the hospital.
Median New York Heart Association class at discharge was 1 (range,
1–2).