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Catheter ablation of AF viable method for patients with HFpEF
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Catheter ablation was a safe and effective method for the treatment of atrial fibrillation in patients with HF with preserved ejection fraction, according to new analysis from Japan.
The technique was most effective when used multiple times and in conjunction with medication.
Seventy-four patients with AF and HF with preserved ejection fraction (HFpEF) — left ventricular ejection fraction >50% — had catheter ablation. Of those enrolled, 42 had sinus rhythm restored by electrical cardioversion before catheter ablation. All antiarrhythmic drugs were discontinued before the procedure. After catheter ablation, patients were followed for at least 12 months and stratified for analysis by AF recurrence and sinus rhythm maintenance. Mean follow-up time was 34 months.
Success rates were as follows:
- Single catheter ablation procedure with no medication assistance: 27% (n=20);
- Multiple catheter ablation procedures with no medication assistance: 45% (n=33);
- Multiple catheter ablation procedures with medication assistance: 73% (n=54).
The procedure was performed successfully in every patient, there were no major complications and all patients recovered from minor complications, including groin hematoma and post-procedural pulmonary edema.
Using a multivariate analysis, the researchers determined that AF type (HR=1.81; 95% CI, 1.03-3.17) — other than long-standing persistent AF —and lack of hypertension (HR=0.49; 95% CI, 0.24-0.96) were associated with maintenance of sinus rhythm, according to the results.
Mean LVEF increased slightly in those who maintained sinus rhythm after catheter ablation (baseline, 67%; follow-up, 69%), but not in those who did not maintain sinus rhythm (baseline, 66%; follow-up, 66%).
“LV diastolic dysfunction, which is a key feature of HFpEF, may aggravate [left atrial] remodeling and contribute to the arrhythmogenic substrate and development of AF,” the researchers wrote. “Therefore, total AF cure without antiarrhythmic drugs in HFpEF patients may be more difficult than that in other populations.”
Because this was a small, single-arm study, larger, randomized studies with longer follow-up are needed to confirm its findings, the researchers said.
Disclosure: The researchers report no relevant financial disclosures.
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