Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction

Black‐Maier, Eric; Ren, Xinru; Steinberg, Benjamin A.; Green, Cynthia L.; Barnett, Adam S.; Rosa, Normita Sta; Al‐Khatib, Sana M.; Atwater, Brett D.; Daubert, James P.; Frazier‐Mills, Camille; Grant, Augustus O.; Hegland, Donald D.; Jackson, Kevin; Jackson, Larry R.; Koontz, Jason I.; Lewis, Robert K.; Sun, Albert Y.; Thomas, Kevin L.; Bahnson, Tristam D.; Piccini, Jonathan P.

doi:10.1016/j.hrthm.2017.12.001

Cited by 112 publications

(99 citation statements)

References 18 publications

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“…10,[16][17][18] In contrast, catheter ablation of AF has advantages in maintaining sinus rhythm and appears to have similar effects in patients with HFpEF. [7][8][9] In fact, sinus rhythm was maintained in approximately 70% of the ABL group patients in the present study, which was consistent with the previous reports. [7][8][9] Although ABL group seemed to have advantages, Kaplan-Meier curve analysis comparing the ABL group and patients who received rhythm control by the use of amiodarone showed no significant difference regarding the maintenance of sinus rhythm in the present study.…”

Section: Predictors Of Hf Rehospitalizationsupporting

confidence: 93%

“…[7][8][9] In fact, sinus rhythm was maintained in approximately 70% of the ABL group patients in the present study, which was consistent with the previous reports. [7][8][9] Although ABL group seemed to have advantages, Kaplan-Meier curve analysis comparing the ABL group and patients who received rhythm control by the use of amiodarone showed no significant difference regarding the maintenance of sinus rhythm in the present study. This discrepancy might be due to the small number of patients and the difference in the follow-up methodology.…”

Section: Predictors Of Hf Rehospitalizationsupporting

confidence: 93%

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Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction

Fukui

Tanino

Yamaguchi

et al. 2020

Cardiovasc electrophysiol

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Background Atrial fibrillation (AF) is associated with heart failure (HF) rehospitalization in patients with heart failure with preserved ejection fraction (HFpEF). Objective We tested the hypothesis that catheter ablation of AF could reduce HF rehospitalization compared with conventional pharmacotherapy in patients with HFpEF. Methods Eighty‐five consecutive HFpEF (EF ≥ 50% and a history of HF hospitalization) patients diagnosed as AF by 12‐lead electrocardiogram were retrospectively analyzed. Thirty‐five patients who received catheter ablation (ABL group) were compared with 50 patients treated by antiarrhythmic drugs and/or beta‐blockers (CNT group). The primary endpoint was rehospitalization due to HF. Results The patients characteristics did not differ between the two groups including, age (71 ± 8 vs 71 ± 13 years; P = .637), female sex (34% vs 36%; P = .870), mean plasma brain natriuretic peptide (145 ± 112 vs 195 ± 153 pg/mL; P = .111), mean left ventricular ejection fraction (62% ± 8% vs 61% ± 9%; P = .624), and type of AF (nonparoxysmal AF 60% vs 62%; P = .852). Amiodarone was continued 40% (14 out of 35) and 40% (20 out of 70) in ABL and CNT groups, respectively (P = 1.000). Neither major complication nor major side effect was observed during the follow‐up period. During a mean follow‐up period of 792 ± 485 days, Kaplan‐Meier curve analysis showed that significantly more patients in the ABL group were free from HF rehospitalization (log‐rank P = .0039). Additionally, multivariate analysis revealed that catheter ablation of AF was the only preventive factor of HF rehospitalization (OR = 0.15; 95% CI: 0.04‐0.46; P < .001). Conclusions Catheter ablation of AF reduced HF rehospitalization compared with conventional pharmacotherapy in patients with HFpEF in our institute. Multicenter randomized study is warranted to confirm the result.

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Section: Predictors Of Hf Rehospitalizationsupporting

confidence: 93%

Section: Predictors Of Hf Rehospitalizationsupporting

confidence: 93%

Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction

Fukui

Tanino

Yamaguchi

et al. 2020

Cardiovasc electrophysiol

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“…Entrance and exit block was routinely confirmed with multi‐electrode catheters, pacing, and adenosine. Additional ablation beyond PVI was performed at the operator's discretion, as previously described . Electroanatomic mapping systems were utilized in all cases (CARTO [Biosense‐Webster Inc, Diamond Bar, CA] or NavX, St Jude Medical, Inc, Minneapolis, MN).…”

Section: Methodsmentioning

confidence: 99%

“…In addition to in-office visits with 12-lead ECG at 3, 6, and 12 months, ambulatory ECG monitoring or device interrogations were obtained in the presence of symptoms to ascertain arrhythmia recurrence, as we have previously described. 11 Continuation of antiarrhythmic drug therapy was left to the discretion of the primary electrophysiologist, with roughly half of patients remaining on antiarrhythmic drug therapy at 12-month follow-up, as previously described. 10 To assess the predictive ability of the CAAP-AF and APPLE scores, logistic regression modeling was used with AF recurrence as the outcome, and score (categorical) as the single predictor.…”

Section: Postablation Management and Ambulatory Monitoringmentioning

confidence: 99%

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP‐AF risk scoring systems

Black‐Maier¹,

Parish

Steinberg

et al. 2019

Pacing Clinical Electrophis

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Background Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP‐AF and APPLE) have been developed to predict the likelihood of AF recurrence after ablation, have not been validated specifically in patients with AF and HF. Methods We analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in a cohort of 230 consecutive patients with AF and HF undergoing PVI in the Duke Center for Atrial Fibrillation registry from 2009‐2013. Results During a follow‐up period of 12 months, 76 of 230 (33%) patients with HF experienced recurrent AF after ablation. The median APPLE and CAAP‐AF scores were 1.5 ([Q1, Q3]: [1.0, 2.0]) and 4.0 ([Q1, Q3]: [3.0, 5.0]), respectively and were not different from those patients with and without recurrent AF. Freedom from AF was not different according to APPLE and CAAP‐AF scores. Discrimination for recurrent AF with the CAAP‐AF score was modest with a C‐statistic of 0.60 (95% CI 0.52‐0.67). Discrimination with the APPLE score was similarly modest, with a C‐statistic of 0.54 (95% CI: 0.47‐0.62). Conclusions Validated predictive risk scores for recurrent AF after catheter ablation exhibit limited predictive ability in cohorts of AF and HF. Additional tools are needed to facilitate risk stratification and patient selection for AF ablation in patients with concomitant HF.

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“…Machino‐Ohtsuka et al 5 first demonstrated the safety and efficacy of AF ablation in AF‐HFpEF, showing a success rate of 73% with one or two procedures and pharmacotherapy, and improved diastolic function associated with sinus rhythm. In another retrospective analysis, Black‐Maier et al 6 concluded that procedure success rate and functional improvement after AF ablation were similar in HFrEF and HFpEF. More recently, a propensity‐matched cohort study showed that rhythm control in AF‐HFpEF via either ablation or medication led to a significantly reduced composite of cardiovascular death and HF hospitalization compared with rate control 7 .…”

mentioning

confidence: 97%

Atrial fibrillation ablation in congestive heart failure with preserved ejection fraction: Tackling the vicious twins

Qin

Heist

2020

Cardiovasc electrophysiol

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Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction

Cited by 112 publications

References 18 publications

Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction

Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP‐AF risk scoring systems

Atrial fibrillation ablation in congestive heart failure with preserved ejection fraction: Tackling the vicious twins

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