Catheter ablation improved ejection fraction in persistent AF patients: a DECAAF-II sub analysis

Abstract

Aims The aim of our study was to assess differences in post-ablation atrial fibrillation (AF) recurrence and burden and to quantify the change in LVEF across different congestive heart failure (CHF) subcategories of the DECAAF-II population. Methods and results Differences in the primary outcome of AF recurrence between CHF and non-CHF groups was calculated. The same analysis was performed for the three subgroups of CHF and the non-CHF group. Differences in AF burden after the 3-month blanking period between CHF and non-CHF groups was calculated. Improvement in LVEF was calculated and compared across the three CHF groups. Improvement was also calculated across different fibrosis stages. There was no significant differences in AF recurrence and AF burden after catheter ablation between CHF and non-CHF patients and between different CHF subcategories. Patients with heart failure with reduced ejection fraction (HFrEF) experienced the greatest improvement in EF following catheter ablation (CA, 16.66% ± 11.98, P < 0.001) compared to heart failure with moderately reduced LVEF, and heart failure with preserved EF (10.74% ± 8.34 and 2.00 ± 8.34 respectively, P-value < 0.001). Moreover, improvement in LVEF was independent of the four stages of atrial fibrosis (7.71 vs. 9.53 vs. 5.72 vs. 15.88, from Stage I to Stage IV respectively, P = 0.115). Conclusion Atrial fibrillation burden and recurrence after CA is similar between non-CHF and CHF patients, independent of the type of CHF. Of all CHF groups, those with HFrEF had the largest improvement in LVEF after CA. Moreover, the improvement in ventricular function seems to be independent of atrial fibrosis in patients with persistent AF.

Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta‐analysis

“…| 723 simultaneously examining the outcomes of catheter ablation across the spectrum of three HF subcategories. 68 Overall, our analyses have shown that the presence of AF significantly accentuate the risks of hard clinical endpoints in the different HF subcategories, especially in HFpEF and HFmrEF. Our results provide rationale for future studies evaluating treatments including ablation and their outcomes across the three HF subcategories.…”

“…It has been observed that there is no difference between efficacy and safety outcomes of catheter ablation between HFpEF and HFrEF 66,67 . There have not been many studies simultaneously examining the outcomes of catheter ablation across the spectrum of three HF subcategories 68 …”

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

“…BNP is a widely used biomarker of HF and elevated levels have diagnostic and clinical utility among individuals with HF 10 . Several variables are predictive of arrhythmia recurrence following ablation, including age, left atrial volume, and duration of AF 10–12 . Even though natriuretic peptides are primarily produced by ventricular myocytes, atrial secretion of BNP is increased in individuals with AF 13 .…”

“…10 Several variables are predictive of arrhythmia recurrence following ablation, including age, left atrial volume, and duration of AF. [10][11][12] Even though natriuretic peptides are primarily produced by ventricular myocytes, atrial secretion of BNP is increased in individuals with AF. 13 Natriuretic peptides may be predictive in AF due to changes in the left atrium, including increased pressure and volume, fibrosis, hypertrophy, and inflammation.…”

The Correlates of Atrial Fibrillation in a Random Sample of Congolese Inhabitants of the City of Kinshasa, the Democratic Republic of the Congo

“…The gold standard diagnosis of AF is 12-lead ECG recording. Since the examination is difficult to perform in mass field surveys, several tools have been validated for screening with convincing reliability [5][6][7][8][9][10][11][12][13][14]. We used Alivecor Kardia software embedded on a smartphone with the aim to explore the epidemiological profile of AF a poorly recognized disease among the general Congolese partly because such information is not yet available.…”