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

Journal Article

Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF).The purpose of this study was to compare outcomes of AF ablation in patients with HFpEF vs HF with reduced ejection fraction (HFrEF).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.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.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

  • December 5, 2017

Published In

PubMed 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


  • eng