Key result
Cryoballoon ablation for AF yields similar long-term sinus rhythm maintenance across HFmrEF, HFpEF, and no HF.
Why the study?
Limited data are available on the outcomes of cryoballoon ablation-based pulmonary vein isolation for atrial fibrillation in patients with HFpEF and HFmrEF.
Does cryoballoon ablation-based pulmonary vein isolation improve sinus rhythm maintenance and cardiac function in patients with atrial fibrillation and HFpEF or HFmrEF compared to those without HF?
Cohort (n=651)
Yes
Does cryoballoon ablation-based pulmonary vein isolation improve sinus rhythm maintenance and cardiac function in patients with atrial fibrillation and HFpEF or HFmrEF compared to those without HF?
Absolute Event Rate: 75.2% vs 79.6%
p-value: p=0.334
Cryoballoon ablation is safe and effective for maintaining sinus rhythm and improving cardiac function in patients with atrial fibrillation and HFpEF or HFmrEF, with outcomes comparable to patients without heart failure.
Cryoballoon ablation appears feasible in AF with HFpEF/HFmrEF; extends observational data but leaves open randomized confirmation of benefit.
AIMS: Limited data are available on the outcomes of cryoballoon ablation (CBA)-based pulmonary vein isolation (PVI) for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF). The present study aimed to evaluate the safety and effectiveness of CBA in such patients. METHODS AND RESULTS: Consecutive patients with AF referred for CBA-based PVI from two highly experienced electrophysiology centres were included in this retrospective study. Of 651 patients undergoing CBA, 471 cases were divided into four groups: No HF (n = 255), HFpEF (n = 101), HFmrEF (n = 78), and HF with reduced ejection fraction (n = 37). Similar early recurrence of atrial arrhythmia was found among groups (16.2% vs. 15.4% vs. 14.9% vs. 12.2%, P = 0.798), and no significant difference of long-term sinus rhythm (SR) maintenance was identified among the HFmrEF, HFpEF, and No HF groups (71.8% vs. 75.2% vs. 79.6%, P = 0.334). CBA is safe for patients with HFmrEF and HFpEF with similar complications compared with the No HF group (3.8% vs. 4.0% vs. 3.1%, P = 0.814). The reassessment of cardiac function after CBA showed that patients with HF indicated beneficial outcomes. Left atrial diameter (LAD) and left ventricular ejection fraction were significantly improved in the HFmrEF group. There were 41.6% of patients in the HFpEF group who were completely relieved from HF. LAD and New York Heart Association (NYHA) were associated with recurrence in the HFpEF and HFmrEF groups, and the maintenance of SR was an independent predictor of NYHA improvement for all HF groups. CONCLUSIONS: Patients with HFmrEF and HFpEF could benefit from CBA with high SR maintenance and significant HF improvement.
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Chen et al. (2022) conducted a cohort in Atrial fibrillation and heart failure (n=651). Cryoballoon ablation vs. No heart failure was evaluated on Long-term sinus rhythm maintenance (p=0.334). Cryoballoon ablation for atrial fibrillation resulted in similar long-term sinus rhythm maintenance among patients with HFmrEF (71.8%), HFpEF (75.2%), and no HF (79.6%, P=0.334).
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