Key result
Atrial fibrillation affects ~72% of hospitalized HFpEF patients, alongside high rates of pacemaker implantation.
Why the study?
Arrhythmias frequently occur during decompensation episodes in HFpEF and worsen outcomes, but the arrhythmic profile in this population remains incompletely characterized.
Cohort (n=1,066)
No
In a real-world HFpEF cohort, supraventricular arrhythmias and conduction anomalies were highly prevalent, with over 40% of patients requiring pacemaker implantation.
High AF and pacemaker rates in HFpEF support arrhythmia surveillance; leaves open optimal management strategies.
Background Heart failure with preserved ejection fraction (HFpEF) represents approximately 50% of all heart failure cases. Arrythmias are frequently seen during decompensation episodes and contribute to prolonged hospitalisation and increased mortality. Nevertheless, the arrhythmic profile of patients with HFpEF remains incompletely characterised. Purpose The objective of this study is to assess the prevalence and types of arrhythmias in patients with HFpEF followed in our hospital during 2024, and to evaluate the need for device therapy or ablation. Methods A retrospective observational cohort study was conducted in all patients hospitalised with a diagnosis of HFpEF during 2024. The following arrhythmias were assessed: atrial fibrillation (AF), atrial flutter (AFl), atrial tachycardia (AT), ventricular extrasystoles (VES), non-sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block (AVB), sick sinus syndrome (SSS). Device implantation – pacemaker (PM) and cardiac defibrillator (ICD) and catheter ablation procedures performed during follow-up were recorded. Descriptive statistics were used to summarize the prevalence of each arrhythmia and intervention. Results Demographic characteristics: 1066 patients (573 male, mean age 71.093 ± 9.43 years) with HFpEF were included. The prevalence of supraventricular arrhythmias was high: AF was documented in 772 patients (72.42%), AFl in 130 patients (12.19%) and AT in 15 patients (1.4%). Sustained ventricular arrhythmias (VT, VF) were documented in 32 patients (3%) and NSVT was documented in 12 patients (1.12%). AVB was documented in 301 patients (28%) and SSS was documented in 172 patients (16.13%). Regarding rhythm management intervention: 165 patients (15.4%) required cardioversion for management of the supraventricular arrhythmia, 82 patients (7.7%) with AFl underwent catheter ablation and 7 patients (0.65%) with AF underwent catheter ablation. Conduction anomalies were also clinically relevant in 301 patients (28.23%) presenting AVB and 172 patients (16.13%) presenting SSS. Out of those, 457 patients (42.8%) required pacemaker implantation and 20 patients (1.8%) required ICD implantation for primary (7 patients – 0.65%) or secondary prevention (13 patients – 1.2%) mainly associated with coronary artery disease. Conclusion In this large real-world HFpEF cohort, AF was highly prevalent (72.42%), while ventricular arrhythmias were less common (3%), mainly in patients with coronary artery disease and structural heart disease. These findings highlight the arrhythmic burden in patients with HFpEF and support systematic rhythm monitoring. Further studies are needed to refine risk stratification and optimize management, including advanced rhythm control interventions.
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Bondoc et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,066). Heart failure with preserved ejection fraction (HFpEF) was evaluated on Prevalence and types of arrhythmias, and need for device therapy or ablation. Among 1,066 patients hospitalized with HFpEF, atrial fibrillation was highly prevalent (72.4%), whereas ventricular arrhythmias were less common (3%), and 42.8% required pacemaker implantation.
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