METHODS: Using the TriNetX research network, we identified adult patients with AF who underwent rhythm control therapy, including antiarrhythmic drugs, cardioversion, or catheter ablation. Patients were categorized into two cohorts based on the presence or absence of HH. Clinical outcomes, including ischemic stroke, major bleeding, all-cause readmission, and heart failure (HF) exacerbation, were assessed at both 1-year and 5-year follow-up. Further subanalyses were performed to compare patients with HH who underwent surgical repair with those who did not, as well as patients with HH who underwent repair with those without HH. Propensity score matching (PSM) was applied separately to each cohort to adjust for differences in age, sex, comorbidities, and medication use, ensuring balanced baseline characteristics.
RESULTS: We identified 2,348,576 patients with AF who underwent rhythm control strategies. Among them, 246,010 (10.5%; mean age 74.2 ± 11.0 years; 51.2% female) had HH, while 2,102,566 (89.5%; mean age 70.8 ± 12.7 years; 40.0% female) did not. After PSM, 243,376 patients were included in each cohort. The presence of HH was associated with significantly higher odds of ischemic stroke (OR 1.11, 95% CI: 1.09-1.13 at 1 year; OR 1.14, 95% CI: 1.13-1.16 at 5 years), major bleeding (OR 1.90, 95% CI: 1.86-1.93 at 1 year; OR 1.78, 95% CI: 1.75-1.80 at 5 years), and all-cause readmission (OR 1.11, 95% CI: 1.10-1.12 at 1 year; OR 1.16, 95% CI: 1.15-1.18 at 5 years) compared to patients without HH (all p