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Undiagnostic Heart Failure With Preserved Ejection Fraction in Atrial Fibrillation Patients Undergoing Catheter
Masanaru Sawada1, Ryuta Watanabe1, Koichi Nagashima1
1Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan.
Insights
Catheter ablation (CA) for atrial fibrillation (AF) significantly improved heart failure with preserved ejection fraction (HFpEF) symptoms in patients. AF recurrence was not linked to HFpEF, suggesting HFpEF features are reversible after CA.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) frequently coexist.
- The prevalence of HFpEF in AF patients undergoing catheter ablation (CA) is not well-established.
Purpose of the Study:
- To determine the prevalence of HFpEF among AF patients undergoing CA.
- To assess the impact of CA on HFpEF features using the HFA-PEFF score.
- To identify predictors of HFpEF score improvement post-CA.
Main Methods:
- 127 AF patients with preserved ejection fraction (≥50%) undergoing initial CA were studied.
- The HFA-PEFF score was assessed before and 1 year after CA.
- Patients were categorized by baseline HFA-PEFF score (low, intermediate, high).
Main Results:
- 23.6% of patients had established HFpEF (score ≥5), 59.8% had suspected HFpEF (2-4), and 16.5% had unlikely HFpEF (≤1).
- AF freedom at 1 year was high across all groups (86.4-91.7%).
- 70.1% of patients showed a ≥1-point improvement in HFA-PEFF score post-CA, with no patients having a score ≥5 at 1 year.
Conclusions:
- HFpEF or suspected HFpEF is common in AF patients considered for CA.
- CA did not impact AF recurrence but significantly improved HFpEF features, indicating potential reversibility.
Background:
Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) often coexist, but the prevalence of HFpEF among AF patients undergoing catheter ablation (CA) remains unclear.
Methods:
We studied 127 AF patients with preserved ejection fraction (≥ 50%) undergoing initial CA. The Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptides, Functional testing, and Final etiology (HFA-PEFF) score was assessed 2 weeks before and 1 year after CA. Patients were grouped as low (0-1), intermediate (2-4), or high (5-6). The primary endpoint was AF freedom at 1 and 2 years; secondary endpoints were changes in HFA-PEFF score; tertiary endpoint was predictors of score improvement.
Results:
Of 127 patients, 30 (23.6%) had HFpEF (score ≥ 5), 76 (59.8%) suspected (2-4), and 21 (16.5%) unlikely (≤ 1). Median follow-up 24.4[ 12.5-29.5] months. AF freedom at 1 year was high (86.4%, 91.7%, 89.7%; p = 0.66). Higher baseline score correlated with older age, female sex, hypertension, larger left atrial volume index (LAVI), elevated average E/e', and increased left ventricular mass index. We divided patients into two groups: those with ≥ 1-point score improvement after CA (n = 89, 70.1%) and those whose score remained unchanged or worsened (n = 38, 29.9%). Improvement was associated with older age, larger LAVI, higher average E/e', and elevated N-terminal pro-B-type natriuretic peptide. Multivariate analysis identified septal e' and LAVI as predictors. No patients had a score ≥ 5 at 1 year.
Conclusions:
HFpEF or suspected HFpEF was common in AF CA candidates but not linked to recurrence. CA remarkably improved HFpEF features, suggesting reversibility.
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