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).