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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Black-Maier, E; Ren, X; Steinberg, BA; Green, CL; Barnett, AS; Rosa, NS; Al-Khatib, SM; Atwater, BD; Daubert, JP; Frazier-Mills, C; Grant, AO; Hegland, DD; Jackson, KP; Jackson, LR; Koontz, JI; Lewis, RK; Sun, AY; Thomas, KL; Bahnson, TD; Piccini, JP

Published Date

  • May 2018

Published In

Volume / Issue

  • 15 / 5

Start / End Page

  • 651 - 657

PubMed ID

  • 29222043

Pubmed Central ID

  • 29222043

Electronic International Standard Serial Number (EISSN)

  • 1556-3871

International Standard Serial Number (ISSN)

  • 1547-5271

Digital Object Identifier (DOI)

  • 10.1016/j.hrthm.2017.12.001

Language

  • eng