D-MP13-06 - Catheter Ablation In Patients With Atrial Fibrillation And Heart Failure With Preserved Ejection Fraction - A Propensity Score Matched Analysis (ID 28)
Background: Catheter ablation has become a standard of care to treat symptomatic paroxysmal and persistent atrial fibrillation (AF). Heart failure with preserved ejection fraction (HFpEF) is often aggravated by AF, leading to increased symptoms and higher morbidity and mortality. The impact of catheter ablation in patients with HFpEF and AF is not known.
Objective: We compared the clinical outcomes of catheter ablation versus conservative therapy in patients with AF and concomitant HFpEF.
Methods: Patients with AF and concomitant HFpEF who were treated by catheter ablation were compared to patients who were treated conservatively. To account for a potential selection bias we conducted propensity score matching. Clinical and echocardiographic parameters were compared at baseline and follow-up. Primary endpoint was a combination of death and cardiovascular hospitalization.
Results: Of 752 patients with atrial fibrillation and echocardiographic signs of diastolic dysfunction treated at our institution, we identified 127 patients with a consistent diagnosis of HFpEF according to heart failure guidelines. By propensity score matching we matched 42 patients treated by catheter ablation to 42 patients who were treated conservatively. Patients in the catheter ablation group received a mean of 1.6±0.9 ablation procedures. Mean follow-up was 38±22 months. Freedom from atrial arrhythmia after four years was 52% in the ablation group and 22% in the conservative group. The primary endpoint occurred significantly more often in the conservative group than in the ablation group (HR: 0.47; 95% CI: 0.28-0.79; p=0.004) which was mainly driven by cardiovascular hospitalizations. Heart failure symptoms improved significantly after catheter ablation (NYHA-class baseline: 2.5±0.7, follow-up: 1.6±0.7; p<0.001) while in the control group there was a trend to aggravation of symptoms (NYHA-class baseline: 2.3±0.5, follow-up: 2.5±0.8, p=0.06).
Conclusion: Catheter ablation in patients with AF and HFpEF as compared to medical therapy alone leads to significant improvement of heart failure symptoms and a decrease in cardiovascular hospitalizations.