[Atrial fibrillation-Syndromic phenotype in HFpEF or primary disease?]

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are increasingly prevalent cardiovascular conditions.
• These conditions often coexist and share common risk factors like hypertension, diabetes, obesity, and renal insufficiency.
• Current treatments for heart failure with reduced ejection fraction (HFrEF) lack comparable benefits for HFpEF patients.

Purpose of the Study:

• To investigate the relationship between atrial fibrillation and HFpEF.
• To evaluate the potential benefits of pulmonary vein isolation for HFpEF patients with AF.
• To highlight the need for prospective data on interventional treatment for this patient group.

Main Methods:

• Review of existing literature and retrospective analyses of patients with HFpEF and AF.
• Focus on outcomes following pulmonary vein isolation (PVI) for AF in HFpEF patients.
• Mention of ongoing prospective randomized trials like the AMPERE study.

Main Results:

• Retrospective data suggest PVI for AF in HFpEF patients may improve New York Heart Association (NYHA) functional class and diastolic function.
• Atrial fibrillation is associated with reduced survival and negatively impacts heart and kidney function in HFpEF.
• Prospective studies are needed to confirm these findings.

Conclusions:

• Atrial fibrillation poses a significant threat to HFpEF patients, affecting survival and organ function.
• Interventional treatment of AF, such as PVI, shows promise for improving outcomes in HFpEF.
• Further prospective randomized trials are crucial to establish definitive treatment strategies.