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Differential HFpEF Response After Catheter Ablation in Persistent AF Patients With Small Low Voltage Areas
Yasuyuki Egami1, Taichi Mukai1, Mikako Kise1
1Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Background:
Low voltage areas (LVAs) in the left atrium (LA) is associated with atrial fibrillation (AF) recurrence and heart failure with preserved ejection fraction (HFpEF). The clinical significance of small LVAs (< 5.0 cm2) in patients with persistent atrial fibrillation (PerAF) remains unclear. This study evaluated the impact of catheter ablation (CA) on HFpEF status in PerAF patients with small LVAs.
Methods:
We included 62 consecutive PerAF patients with total LA LVAs < 5.0 cm2 undergoing initial CA between June 2019 and March 2023. Patients were divided by the median LVA into the sLVA-Low (0.0-1.6 cm2) and sLVA-High (1.7-4.9 cm2). HFA-PEFF scores were assessed at baseline and 12 months. Changes in HFA-PEFF scores (ΔHFA-PEFF), arrhythmia recurrence, and adverse clinical events were compared.
Results:
Baseline HFA-PEFF scores were higher in sLVA-High than in sLVA-Low (4 [3-4] vs. 2 [2-3], p = 0.013). At 12 months, HFA-PEFF scores remained elevated in sLVA-High (3.5 [2-5] vs. 2 [2-4], p = 0.037), with a greater prevalence of HFA-PEFF scores 5-6 (30% vs. 8%, p = 0.043). However, ΔHFA-PEFF scores, AF recurrence rates, the incidence of adverse events did not differ significantly between the two groups.
Conclusion:
Among PerAF patients with small LVAs (<5 cm2), relatively larger LVAs within the small range were associated with worse HFpEF profiles despite similar rhythm outcomes. Even small LVAs may indicate substrate prone to HFpEF progression, warranting careful follow-up.
