Restoration and maintenance of sinus rhythm after AF ablation in patients with early HFpEF significantly improved peak exercise PCWP (from 29 to 23 mmHg, P<0.01) and MLHF scores.
Cohort (n=54)
Does AF ablation improve symptoms and exercise haemodynamic parameters in patients with symptomatic AF and early HFpEF?
Catheter ablation for atrial fibrillation in patients with comorbid early HFpEF improves haemodynamic parameters and symptoms, particularly when sinus rhythm is successfully maintained.
p-value: p=<0.01
AIMS: The impact of atrial fibrillation (AF) ablation in early heart failure with preserved ejection fraction (HFpEF) is unknown. Our aim was to determine the impact of AF ablation on symptoms and exercise haemodynamic parameters of early HFpEF. METHODS AND RESULTS: Symptomatic AF patients referred for index AF ablation with ejection fraction ≥50% underwent baseline quality of life questionnaires, echocardiography, cardiac magnetic resonance imaging, exercise right heart catheterisation (exRHC), and brain natriuretic peptide (BNP) testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15 mmHg or peak exercise PCWP ≥25 mmHg. Patients with HFpEF were offered AF ablation and follow-up exRHC ≥6 months post-ablation. Of 54 patients undergoing baseline evaluation, 35 (65%) had HFpEF identified by exRHC. HFpEF patients were older (64 ± 10 vs. 54 ± 13 years, P < 0.01), and more frequently female (54% vs. 16%, P < 0.01), hypertensive (63% vs. 16%, P < 0.001), and suffering persistent AF (66% vs. 11%, P < 0.001), compared to those without HFpEF. Twenty HFpEF patients underwent AF ablation and follow-up exRHC 12 ± 6 months post-ablation. Nine (45%) patients no longer fulfilled exRHC criteria for HFpEF at follow-up. Patients remaining arrhythmia free (n = 9, 45%) showed significant improvements in peak exercise PCWP (29 ± 4 to 23 ± 2 mmHg, P < 0.01) and Minnesota Living with Heart Failure (MLHF) score (55 ± 30 to 22 ± 30, P < 0.01) while the remainder did not (PCWP 31 ± 5 to 30.0 ± 4 mmHg, P = NS; MLHF score 55 ± 23 to 25 ± 20, P = NS). CONCLUSION: Heart failure with preserved ejection fraction frequently coexists in patients with symptomatic AF and preserved ejection fraction. Restoration and maintenance of sinus rhythm in patients with comorbid AF and HFpEF improves haemodynamic parameters, BNP and symptoms associated with HFpEF.
Sugumar et al. (Wed,) conducted a cohort in Atrial fibrillation and early heart failure with preserved ejection fraction (HFpEF) (n=54). Catheter ablation for atrial fibrillation vs. Patients not remaining arrhythmia free was evaluated on Peak exercise pulmonary capillary wedge pressure (PCWP) and Minnesota Living with Heart Failure (MLHF) score (p=<0.01). Restoration and maintenance of sinus rhythm after AF ablation in patients with early HFpEF significantly improved peak exercise PCWP (from 29 to 23 mmHg, P<0.01) and MLHF scores.