Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction - AF Ablation for HFpEF

Mar 02, 2023
Font Size
A
A
A
Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Published:
03/01/2023
Original Posted Date:
03/02/2023
References

Contribution To Literature:

The goal of the AF Ablation for HFpEF trial showed that AF ablation improves invasive exercise hemodynamic parameters.

Description:

The goal of the trial was to evaluate atrial fibrillation (AF) ablation compared with medical therapy among patients with heart failure with preserved ejection fraction (HFpEF) and AF.

Study Design

  • Randomized
  • Parallel

Patients with HFpEF and AF were randomized to AF ablation (n = 16) vs. usual care (n = 15).

  • Total number of enrollees: 31
  • Duration of follow-up: 6 months
  • Mean patient age: 66 years
  • Percentage female: 52%
  • Percentage with diabetes: 13%

Inclusion criteria:

  • Patients ≥18 years of age with HFpEF (left ventricular ejection fraction ≥50%)
  • Paroxysmal or persistent AF
  • Right heart catheterization documenting pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg at rest or ≥25 mm Hg with exercise

Exclusion criteria:

  • Long-standing persistent AF
  • Significant coronary or valvular heart disease
  • Body mass index >40 kg/m2

Other salient features/characteristics:

  • Median AF duration: 1.7 years
  • Persistent AF: 81%

Principal Findings:

The primary outcome, peak exercise PCWP at 6 months, was 25.4 mm Hg in the ablation group vs. 28.9 mm Hg in the control group (p = 0.04).

Secondary outcomes:

  • Peak VO2 at 6 months: 23 mL/kg/min in the ablation group vs. 16 mL/kg/min in the control group (p < 0.01)
  • N-terminal pro–B-type natriuretic peptide (NT-proBNP) at 6 months: 140 ng/L in the ablation group vs. 591 ng/L in the control group (p = 0.04)

Interpretation:

Among patients with HFpEF and paroxysmal or persistent AF, AF ablation improves invasive exercise hemodynamic parameters. The peak exercise PCWP was modestly improved in the ablation group vs. usual care. Peak VO2 and NT-proBNP were also modestly improved for ablation vs. usual care. Larger studies are needed to confirm these findings.

References:

Chieng D, Sugumar H, Segan L, et al. Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction: A Randomized Controlled Trial. JACC Heart Fail 2023;Mar 1:[Epub ahead of print].

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Exercise

Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Exercise, Heart Failure, Hemodynamics, Natriuretic Peptide, Brain, Stroke Volume, Ventricular Function, Left


< Back to Listings