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Atrial fibrillation ablation in heart failure: Findings from the ESC-EHRA EORP Atrial Fibrillation Ablation long-term
Pier Luigi Temporelli1, Elena Arbelo2, Cécile Laroche3
1Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.
Insights
Heart failure patients undergoing atrial fibrillation ablation (AFA) in Europe are a minority, primarily with preserved ejection fraction. Outcomes for these patients were similar to those without heart failure, despite higher comorbidity rates.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation ablation (AFA) is a treatment for atrial fibrillation (AF).
- The clinical profiles and outcomes of AF patients with heart failure (HF) undergoing AFA in Europe are not well-defined.
- Understanding these characteristics is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the clinical profiles and outcomes of heart failure patients undergoing atrial fibrillation ablation in Europe.
- To compare outcomes between heart failure patients and non-heart failure patients receiving AFA.
- To characterize the different phenotypes of heart failure (reduced, mid-range, preserved ejection fraction) within the AFA population.
Main Methods:
- A prospective observational registry of consecutive patients undergoing AFA was conducted across 27 European countries, led by the European Society of Cardiology (ESC).
- A subgroup of patients with heart failure (HF) was analyzed after a 1-year follow-up.
- Patients were categorized based on left ventricular ejection fraction (EF): HFrEF (<40%), HFmEF (40-49%), and HFpEF (≥50%).
Main Results:
- Out of 3582 AF patients, 537 (14.9%) had HF. HF patients had higher rates of diabetes, hypertension, hypercholesterolemia, and structural heart disease.
- In-hospital complications were less frequent in HF patients (5.0% vs. 8.2%).
- One-year outcomes, including AF recurrence (15.4%) and repeat ablations (9.5%), were similar between HF and non-HF groups. The majority of HF patients were HFpEF (77%).
Conclusions:
- Heart failure patients constitute a minority of those undergoing AFA in Europe, with most being the HFpEF phenotype.
- Despite higher comorbidity burdens, HF patients experienced similar in-hospital and 1-year outcomes compared to non-HF patients.
- The limited research on AFA in HFpEF patients contributes to current guideline uncertainties.
Background:
The current practice of atrial fibrillation ablation (AFA) as a treatment option for atrial fibrillation (AF) in patients with heart failure (HF) across Europe, their clinical profiles and outcomes is still undefined.
Methods:
The European Society of Cardiology (ESC) led a prospective observational registry of consecutive patients undergoing AFA, in 27 member countries. The subgroup of patients with HF, followed-up for 1 year, was analyzed and the results are reported.
Results:
Of the 3582 AF patients in the Registry, 537 (14.9%) had HF. Diabetes, hypertension, hypercholesterolemia, CHA2DS2-VASc score ≥ 2, structural heart disease and persistent AF were more common in HF than non-HF patients (all p < 0.001). However the in-hospital complications were less frequent in HF patients (5.0% vs. 8.2% p = 0.01). Both in-hospital and 1-year outcomes, including 1-year AF recurrence (15.4%) and repeat ablations (9.5%), were similar in both groups. We subdivided HF patients according to their left ventricular ejection fraction (EF) at baseline into reduced (HFrEF, <40%), mid-range (HFmEF, 40-49%), or preserved EF (HFpEF, ≥ 50%). Most patients were HFpEF (n 375, 77%), 72 (15%) were HFmEF and 8% HFrEF. The most frequent underlying conditions in HFpEF were hypertension and ischemic heart disease, while those most common in HFmEF and HFrEF were valvular and dilated cardiomyopathy.
Conclusion:
In routine care in Europe, HF patients represent a minority of patients undergoing AFA, and most belong to the HFpEF phenotype. The limited clinical research on AFA HFpEF patients is reflected by the uncertainty expressed in the current AF Guidelines and Expert statements.
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