Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-130 - Reversal Of HFpEF Following Af Ablation In Co-morbid Af And HFpEF (ID 1114)

Abstract

Background: Atrial fibrillation (AF) and Heart Failure with preserved Ejection Fraction (HFpEF) frequently co-exist. The haemodynamic impact catheter ablation (CA) in patients with comorbid AF and HFpEF is not known
Objective: To determine if CA for AF influences HFpEF as defined and measured using invasive haemodynamics (exercise right heart catheterization, ExRHC) in patients with comorbid AF and HFpEF
Methods: Consecutive patients scheduled for AF ablation with signs of symptoms of heart failure, elevated BNP, and EF >50% underwent exRHC prior to CA. Patients with resting PCWP ≥ 15mmHg or peak exercise PCWP ≥25 mmHg were diagnosed as having HFpEF. Follow-up exRHC was performed ≥6 months post CA. Baseline versus follow-up exRHC indices were compared
Results: Of 26 consecutive HFpEF patients undergoing AF ablation, 16(61.5%) returned for a follow up ExRHC and were included in the analysis. Patients were aged 64.8 ± 8.6 years (50% female) with BMI of 31.1 ± 4.6 Kg/m2and BNP of 121.5 ± 92.4 at baseline. At 12 ±6 months, 7 (43.8%) patients remained arrhythmia free. Overall, resting PCWP remained unchanged following CA (12.0 ± 6.3 vs 11.6 ± 4.2 p = 0.4), but peak exercise PCWP fell significantly (30.0 ± 4.2 vs 26.9 ± 4.9, p = 0.03). Among patients remaining arrhythmia free post CA, peak exercise PCWP fell from 29.0 ±4.1 to 23.1 ±2.0 mmHg (p = 0.004). Patients with arrhythmia recurrence showed no difference in peak exercise PCWP (30.8 ±4.4 to 29.8 ±4.6 p = 0.62). Seven patients (43.8%) no longer met the criteria for HFpEF at the time of follow-up exRHC
Conclusion: Catheter ablation for AF reverses adverse haemodynamic changes associated with HFpEF and is a promising treatment strategy for co-morbid AF and HFpEF
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