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

Research paper by Eric E Black-Maier, Xinru X Ren, Benjamin A BA Steinberg, Cynthia L CL Green, Adam S AS Barnett, Normita Sta NS Rosa, Sana M SM Al-Khatib, Brett D BD Atwater, James P JP Daubert, Camille C Frazier-Mills, Augustus O AO Grant, Donald D DD Hegland, Kevin P KP Jackson, Larry R LR Jackson, Jason I JI Koontz, et al.

Indexed on: 10 Dec '17Published on: 10 Dec '17Published in: Heart Rhythm



Abstract

Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF).Compare outcomes of AF ablation in patients with HFpEF versus 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 out of 230 patients had non-paroxysmal AF (62.8% HFpEF vs 63.0% HFrEF). Patients with HFpEF had a smaller mean left atrial diameter (4.4+0.8 vs. 4.7+0.7 cm, p=0.013) and were less likely to be taking a beta blocker at baseline (72.9 vs. 85.6%, p=0.022). Median (Q1, Q3) procedure times (233 [192, 290] vs. 233.5 min [193.0, 297.5], p=0.780) and adverse events such as acute HF (3.8 vs. 6.2%, p=0.395) 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 HR=1.47 [95% CI 0.72-3.01]) with similar improvements in NYHA class (-0.32 vs. -0.19, p=0.135) and MAFSI symptom severity (0.23 vs. 0.09, p=0.116) following ablation.Catheter ablation of AF appears to have similar effectiveness in patients with heart failure, 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 HFrEF.

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