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Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction

Published:December 05, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.12.001

      Background

      Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF).

      Objective

      The purpose of this study was to compare outcomes of AF ablation in patients with HFpEF vs HF with reduced ejection fraction (HFrEF).

      Methods

      We performed a retrospective study of 230 patients with HF who underwent AF ablation, including 97 (42.2%) with HFrEF and 133 (57.8%) with HFpEF. Outcomes included adverse events, symptoms (Mayo AF Symptom Inventory [MAFSI]), New York Heart Association (NYHA) functional class, and freedom from recurrent atrial arrhythmia at 12 months.

      Results

      Overall, 150 of 230 patients had nonparoxysmal AF (62.8% HFpEF vs 63.0% HFrEF). Patients with HFpEF had a smaller mean left atrial diameter (4.4 ± 0.8 cm vs 4.7 ± 0.7 cm; P = .013) and were less likely to be taking a beta-blocker at baseline (72.9% vs 85.6%; P = .022). Median (Q1, Q3) procedure times (233 minutes [192, 290] vs 233.5 minutes [193.0, 297.5]; P = .780) and adverse events such as acute HF (3.8% vs 6.2%; P = .395) were similar between HFpEF and HFrEF patients. Freedom from recurrent atrial arrhythmia was not significantly different in HFpEF vs HFrEF patients (33.9% vs 32.6%; adjusted hazard ratio 1.47; 95% confidence interval 0.72–3.01), with similar improvements in NYHA functional class (−0.32 vs −0.19; P = .135) and MAFSI symptom severity (−0.23 vs −0.09; P = .116) after ablation.

      Conclusion

      Catheter ablation of AF seems to have similar effectiveness in patients with HF, regardless of presence of systolic dysfunction. There were no significant differences in procedural characteristics, arrhythmia-free recurrence, or functional improvements between patients with HFpEF and those with HFrEF.

      Keywords

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      Linked Article

      • It is time for catheter ablation to be considered a first-line treatment option in patients with atrial fibrillation and heart failure
        Heart RhythmVol. 15Issue 5
        • Preview
          Atrial fibrillation (AF) and heart failure (HF) often coexist,1 as these 2 conditions share a number of risk factors, such as advanced age, hypertension, valve disease, and myocardial infarction.2 The risk of patients with AF developing HF is 2.7-fold in males and 3.1-fold in females,1 as AF causes varying ventricular activation and decreases cardiac output. The risk of patients with HF developing AF is 1.6-fold in males and 2.7-fold in females3 due to neurohormonal activation (e.g., the renin–angiotensin–aldosterone system), left atrial (LA) dilation caused by elevation of left ventricular (LV) filling pressure that contributes to atrial electroanatomic remodeling, and fibrosis that leads to initiation of AF.
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