Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry

Olshausen, Gesa von; Benson, Lina; Dahlström, Ulf; Lund, Lars H.; Savarese, Gianluigi; Braunschweig, Frieder

doi:10.1002/ejhf.2604

Cited by 19 publications

(19 citation statements)

References 29 publications

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“…In HFpEF, catheter ablation was also associated with a lower risk of recurrent HF hospitalization (incidence rate ratio 0.17; 95% CI 0.07–0.42). Actually, in the study of von Olshausen et al ., 11 the number of ablations performed in AF patients was low, corresponding to 1% of the patients enrolled in Swedish HF Registry. This finding is in agreement with other real‐world reports.…”

Section: Figurementioning

confidence: 97%

“…More recently, AF ablation has gained an important role in rhythm control for AF and is absolutely recommended as first choice option over medical therapy when atrial tachycardiomyopathy is suspected 6 . According to literature, AF ablation may achieve favourable results at mid and long term in patients with HF, even if relatively few studies ( Table 1 ) 11,13–22 classified patients according to LVEF into HFrEF, HFmrEF and HFpEF.…”

Section: Figurementioning

confidence: 99%

“…The need to maintain a short time between AF diagnosis and rhythm control strategies is of special value in AF ablation, as highlighted by recent studies and meta‐analyses, 10 and this may be even more important in HFpEF, taking into account the mutual links and the pathophysiological and clinical convergence existing between AF and HFpEF 5 . In this issue of the Journal, von Olshausen et al 11 . report on data from the Swedish Heart Failure Registry (years 2005–2019) targeted to investigate the association between catheter ablation for AF and outcome, in terms of mortality and HF hospitalizations in patients with HF across the entire LVEF spectrum.…”

Section: Figurementioning

confidence: 99%

“…Actually, in the study of von Olshausen et al, 11 the number of ablations performed in AF patients was low, corresponding to 1% of the patients enrolled in Swedish HF Registry. This finding is in agreement with other real-world reports.…”

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confidence: 97%

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Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

Boriani

Vitolo

Imberti

2022

European J of Heart Fail

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This article refers to 'Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry' by G. von Olshausen et al., published in this issue on pages 1636-1646.Atrial fibrillation (AF) and heart failure (HF) are two common cardiac diseases, affecting 1-2% of the population with a prevalence that rises steeply with age. 1 They are conditioned and promoted by common risk factors and frequently coexist with complex dynamic interactions 1 (Figure 1). Although left ventricular ejection fraction (LVEF) shows substantial limitations in terms of imprecision, intra-, and inter-observer variability, 2 the classification of patients with HF is currently based on three different categories according to LVEF, i.e. patients with preserved (HFpEF, LVEF ≥50%), mildly reduced (HFmrEF, LVEF 41-49%), and reduced ejection fraction (HFrEF, LVEF ≤40%). 3 HFpEF is estimated to account for approximately half of HF cases, even if its epidemiological profile is of complex assessment in consideration of the lack of standardized criteria for its diagnosis in the past and substantial heterogeneity in clinical presentation, underlying aetiology, precipitating factors, and associated comorbidities. 4 The haemodynamic consequences of AF are related to loss of atrial contribution to cardiac output, to increase in heart rate with shortening in the duration of diastole, and to irregularity in diastolic intervals. Loss of atrial transport is particularly significant if there is impairment in left ventricular (LV) filling, due to reduced diastolic compliance, as in many cases of HFpEF. In this patient subset, a high heart rate or an irregular heart rate with frequent short diastolic intervals may be poorly tolerated as well, resulting in increased capillary wedge pressure. 5 Apart from these considerations, it is well acknowledged that a sustained uncontrolled tachycardia with heart rate >120 bpm may be associated at long term with an impairment of LV function, which may result in important worsening of the clinical conditions, unless heart rate can be controlled or sinusThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Section: Figurementioning

confidence: 97%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

mentioning

confidence: 97%

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Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

Boriani

Vitolo

Imberti

2022

European J of Heart Fail

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“…The primary endpoint of all‐cause mortality or first HF hospitalization was lower among patients who underwent AF ablation versus conservative management, irrespective of LVEF. Moreover, catheter ablation was associated with a lower risk of recurrent HF hospitalization in patients with HF and preserved ejection fraction (HFpEF) 41 …”

Section: Devicesmentioning

confidence: 99%

September 2022 at a glance

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Heart Failure With Preserved Ejection Fraction

Redfield

Borlaug

2023

JAMA

173

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ImportanceHeart failure with preserved ejection fraction (HFpEF), defined as HF with an EF of 50% or higher at diagnosis, affects approximately 3 million people in the US and up to 32 million people worldwide. Patients with HFpEF are hospitalized approximately 1.4 times per year and have an annual mortality rate of approximately 15%.ObservationsRisk factors for HFpEF include older age, hypertension, diabetes, dyslipidemia, and obesity. Approximately 65% of patients with HFpEF present with dyspnea and physical examination, chest radiographic, echocardiographic, or invasive hemodynamic evidence of HF with overt congestion (volume overload) at rest. Approximately 35% of patients with HFpEF present with “unexplained” dyspnea on exertion, meaning they do not have clear physical, radiographic, or echocardiographic signs of HF. These patients have elevated atrial pressures with exercise as measured with invasive hemodynamic stress testing or estimated with Doppler echocardiography stress testing. In unselected patients presenting with unexplained dyspnea, the H2FPEF score incorporating clinical (age, hypertension, obesity, atrial fibrillation status) and resting Doppler echocardiographic (estimated pulmonary artery systolic pressure or left atrial pressure) variables can assist with diagnosis (H2FPEF score range, 0-9; score &gt;5 indicates more than 95% probability of HFpEF). Specific causes of the clinical syndrome of HF with normal EF other than HFpEF should be identified and treated, such as valvular, infiltrative, or pericardial disease. First-line pharmacologic therapy consists of sodium-glucose cotransporter type 2 inhibitors, such as dapagliflozin or empagliflozin, which reduced HF hospitalization or cardiovascular death by approximately 20% compared with placebo in randomized clinical trials. Compared with usual care, exercise training and diet-induced weight loss produced clinically meaningful increases in functional capacity and quality of life in randomized clinical trials. Diuretics (typically loop diuretics, such as furosemide or torsemide) should be prescribed to patients with overt congestion to improve symptoms. Education in HF self-care (eg, adherence to medications and dietary restrictions, monitoring of symptoms and vital signs) can help avoid HF decompensation.Conclusions and RelevanceApproximately 3 million people in the US have HFpEF. First-line therapy consists of sodium-glucose cotransporter type 2 inhibitors, exercise, HF self-care, loop diuretics as needed to maintain euvolemia, and weight loss for patients with obesity and HFpEF.

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Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry

Abstract: To investigate the association between catheter ablation for atrial fibrillation (AF) and mortality as well as hospitalization for heart failure (HF) in patients with HF across the ejection fraction (EF) spectrum.

Cited by 19 publications

References 29 publications

Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

September 2022 at a glance

Heart Failure With Preserved Ejection Fraction

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