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

D-PO03-163 - AF Ablation Improves Heart Failure In Patients With Atrial Fibrillation And Concomitant Heart Failure With Preserved Ejection Fraction (ID 348)

  T. Dahme: Honoraria/Speaking/Consulting Fee - Medtronic; Biosense Webster, Inc..


Background: Heart failure with preserved ejection fraction (HFpEF) is often aggravated by atrial fibrillation (AF), leading to increased symptoms and higher morbidity and mortality. Effective therapies for patients with HFpEF and AF have not been established.
Objective: To evaluate the impact of AF ablation on heart failure in patients with HFpEF and AF.
Methods: Patients with HFpEF and AF who received cryoballoon pulmonary vein isolation at our institution were included. Patients with normal left ventricular ejection fraction and absence of diastolic dysfunction served as controls. Arrhythmia recurrence, heart failure symptoms, HFpEF diagnostic criteria, and echocardiographic parameters of ventricular reverse remodelling were assessed during follow-up.
Results: We screened 570 AF patients that had cryoballoon PVI for HFpEF and identified 35 patients fulfilling diagnostic criteria. Arrhythmia recurrence rate of HFpEF patients was significantly higher than in the control group (43% vs. 21% after 3 years, log rank p=0.049). Nevertheless, HFpEF patients showed improvement of heart failure symptoms with a decrease in the mean NYHA functional class from 2.6±0.7 to 1.7±0.9, p<0.001) and 15 patients (42.9%) even had complete resolution of HFpEF by diagnostic criteria after a single ablation procedure (p<0.001). In a multiple ablations analysis resolution of HFpEF occurred in 18 patients (51%) after a mean number of 1.4±0.7 ablation procedures. Reassessment of echocardiographic markers of HFpEF, such as left ventricular mass index (LVMI), intraventricular septal thickness and E/e’ demonstrated left ventricular reverse remodelling. Remarkably, in a multivariate logistic regression model freedom from atrial arrhythmia recurrence was the only predictor of HFpEF resolution. Finally, improvement of heart failure by restoration of sinus rhythm translates into a significant reduction of hospitalization after the ablation procedure.
Conclusion: Restoration of sinus rhythm by AF ablation in patients with HFpEF and AF induces reverse remodeling, improvement of symptoms, resolution of HFpEF and subsequently decrease of hospitalizations.