Atrial fibrillation ablation as first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF): evaluating the impact on patient survival

Younes, Hadi; Noujaim, Charbel; Mekhael, Mario; Chouman, Nour; Assaf, Ala; Kreidieh, Omar; Lim, Chan Ho; Marrouche, Nassir F.; Donnellan, Eoin

doi:10.1080/14779072.2023.2172402

Cited by 2 publications

(4 citation statements)

References 80 publications

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“…Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and affects millions of people worldwide. Despite advances in ablation techniques, patients with persistent atrial fibrillation (PeAF) continue to experience high recurrence rates, with some studies showing rates approaching 50% 9 . Several clinical and imaging parameters have been studied to predict AF recurrence after PVI, but the results have been inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in ablation techniques, patients with persistent atrial fibrillation (PeAF) continue to experience high recurrence rates, with some studies showing rates approaching 50%. 9 Several clinical and imaging parameters have been studied to predict AF recurrence after PVI, but the results have been inconsistent. In our study, we found that pre-ablation BNP levels may predict arrhythmia recurrence following radiofrequency-based PVI in patients with persistent AF without HF (Central Figure ).…”

Section: Discussionmentioning

confidence: 99%

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Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Younes

Mekhael

Feng

et al. 2023

Pacing Clinical Electrophis

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BackgroundBrain natriuretic peptide (BNP) is a marker of myocardial stretch and may have prognostic significance in patients with atrial fibrillation (AF) without heart failure (HF). We investigated the association between baseline BNP levels and arrhythmia recurrence following pulmonary vein isolation (PVI) among patients with persistent AF without HF.MethodsWe analyzed 125 patients with persistent AF without HF who had baseline BNP measured from the DECAAF II trial. The primary outcome was arrhythmia recurrence following ablation. The baseline characteristics across the two groups were compared using Chi‐square test and Wilcoxon rank test accordingly. Cox regression analysis was used to analyze the association between baseline BNP levels and the primary outcome.ResultsAcross the entire cohort, 64 (51%) patients experienced arrhythmia recurrence. When comparing patients who experienced arrythmia recurrence to patients who did not, patients with recurrent arrhythmia had higher levels of pre‐ablation BNP, as evidenced by differences in means (330.05 pg/mL) compared to patients without recurrent arrhythmia (182.39 pg/mL) (p < .05). A cut‐off BNP value of 300 pg/mL provided the largest area under curve (AUC) of receiver‐operating characteristic (ROC) curve on univariate logistic regression. On unadjusted Cox analysis, for every 100 unit increase in BNP, the hazard ratio for the primary outcome increased 1.09 (1.026–1.158) times (p = .004). After adjusting for sex, hypertension, and stroke, the results remained significant (HR = 1.8516, CI 95% [1.0139 – 3.381], p = .045).ConclusionIn the non‐heart failure population, BNP levels predict AF recurrence following PVI in persistent AF patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Younes

Mekhael

Feng

et al. 2023

Pacing Clinical Electrophis

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“…Ablation procedures aim to restore and maintain normal sinus rhythm by targeting the irregular electrical pathways in the atria responsible for AF. The rationale behind ablation in heart failure lies in its potential to improve left ventricular function, reduce symptoms, and enhance the overall quality of life for affected individuals [ 75 , 76 , 77 , 78 , 79 ]. By eliminating or modifying the abnormal electrical circuits contributing to AF, ablation may mitigate the detrimental effects of AF on cardiac hemodynamics and consequently alleviate heart failure symptoms.…”

Section: Future Therapeutic Perspectives In Hfrefmentioning

confidence: 99%

“…By eliminating or modifying the abnormal electrical circuits contributing to AF, ablation may mitigate the detrimental effects of AF on cardiac hemodynamics and consequently alleviate heart failure symptoms. This therapeutic approach represents a valuable strategy in the multidisciplinary management of patients with concurrent AF and HFrEF, offering a potential avenue for improved clinical outcomes and enhanced quality of life [ 75 , 76 , 77 , 78 , 79 ].…”

Section: Future Therapeutic Perspectives In Hfrefmentioning

confidence: 99%

Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium

Kourek,

Briasoulis,

Papamichail

et al. 2024

IJMS

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Heart failure with reduced ejection fraction (HFrEF) is a complex clinical syndrome with significant morbidity and mortality and seems to be responsible for approximately 50% of heart failure cases and hospitalizations worldwide. First-line treatments of patients with HFrEF, according to the ESC and AHA guidelines, include β-blockers, angiotensin receptor/neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, and mineralocorticoid receptor antagonists. This quadruple therapy should be initiated during hospital stay and uptitrated to maximum doses within 6 weeks after discharge according to large multicenter controlled trials. Quadruple therapy improves survival by approximately 8 years for a 55-year-old heart failure patient. Additional therapeutic strategies targeting other signaling pathways such as ivabradine, digoxin, and isosorbide dinitrate and hydralazine combination for African Americans, as well as adjunctive symptomatic therapies, seem to be necessary in the management of HFrEF. Although second-line medications have not achieved improvements in mortality, they seem to decrease heart failure hospitalizations. There are novel medical therapies including vericiguat, omecamtiv mecarbil, genetic and cellular therapies, and mitochondria-targeted therapies. Moreover, mitraclip for significant mitral valve regurgitation, ablation in specific atrial fibrillation cases, omecamtiv mecarbil are options under evaluation in clinical trials. Finally, the HeartMate 3 magnetically levitated centrifugal left ventricular assist device (LVAD) has extended 5-year survival for stage D HF patients who are candidates for an LVAD.

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Atrial fibrillation ablation as first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF): evaluating the impact on patient survival

Cited by 2 publications

References 80 publications

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium

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