Abstract:Background:
Catheter ablation is being increasingly performed for rhythm control of atrial fibrillation (AF). Heart failure (HF) frequently coexists with AF because they share common risk factors.
Study Question:
This study aims at identifying the characteristics and procedural outcomes of patients with HF undergoing catheter ablation of AF.
Study Design:
In this retrospective cohort study, we analyzed 264 c… Show more
“…It has been reported that the procedure and fluoroscopic time in patients with HF are significantly longer than those without HF. Substrate remodeling and enlargement of LA may be some of the important reasons 17,28 . However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies 17,18 .…”
Section: Discussionsupporting
confidence: 91%
“…Substrate remodeling and enlargement of LA may be some of the important reasons. 17,28 However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies. 17,18 The reasons may be as follows: The aforementioned factors may contribute to the nonsignificant differences in the procedure and fluoroscopic time observed for patients with HFpEF and without HF.…”
Section: Discussionsupporting
confidence: 91%
“…Substrate remodeling and enlargement of LA may be some of the important reasons. 17 , 28 However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies. 17 , 18 The reasons may be as follows: (a) according to the baseline data of included studies, patients with HFpEF did not experience significant enlargement of the LA when compared with patients without HF; (b) patients with HFpEF are less likely to develop irreversible and severe fibrosis in the LA 29 ; (c) patients with HFpEF are not accompanied by a significant decrease in LVEF and fewer emergencies that occurred during procedure.…”
Background
Catheter ablation (CA) is an effective treatment for patients with atrial fibrillation (AF). The potential of CA to benefit AF patients with heart failure and preserved ejection fraction (HFpEF) is uncertain.
Hypothesis
CA may be safe and effective for patients with HFpEF.
Methods
The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies evaluating CA for AF patients with HFpEF.
Results
A total of seven trials with 1696 patients were included. Pooled analyses demonstrated similar procedure and fluoroscopy time regarding the use of CA for patients with HFpEF and without HF (weighted mean difference [WMD]: 0.40; 95% confidence interval (CI): −0.01–0.81,
p
= .05 and [WMD: 0.05; 95% CI: −0.18–0.28,
p
= .68]). Moreover, CA was effective in maintaining sinus rhythm (SR) in patients with HFpEF and noninferior for patients without HF [risk ratio (RR): 0.92; 95% CI: 0.76–1.10,
p
= .34). Additionally, CA tended to significantly maintain SR (RR: 4.73; 95% CI: 1.86–12.03,
p
= .001) and reduce rehospitalization for HF compared with medical therapy (RR: 0.36; 95% CI: 0.19–0.71,
p
= .003). However, no significant differences were found between two groups regarding the mortality rate (
p
= .59).
Conclusion
CA is a potential treatment strategy for patients with HFpEF and demonstrates equivalent efficacy to that of patients without HF. Moreover, the benefits of CA in maintaining SR and reducing rehospitalization of HF patients were significantly better than those of medical therapy. Additional randomized controlled trials are warranted to confirm our results.
“…It has been reported that the procedure and fluoroscopic time in patients with HF are significantly longer than those without HF. Substrate remodeling and enlargement of LA may be some of the important reasons 17,28 . However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies 17,18 .…”
Section: Discussionsupporting
confidence: 91%
“…Substrate remodeling and enlargement of LA may be some of the important reasons. 17,28 However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies. 17,18 The reasons may be as follows: The aforementioned factors may contribute to the nonsignificant differences in the procedure and fluoroscopic time observed for patients with HFpEF and without HF.…”
Section: Discussionsupporting
confidence: 91%
“…Substrate remodeling and enlargement of LA may be some of the important reasons. 17 , 28 However, our analysis identified similar procedure and fluoroscopic time periods for patients with HFpEF compared with those without HF, which was in agreement with previous studies. 17 , 18 The reasons may be as follows: (a) according to the baseline data of included studies, patients with HFpEF did not experience significant enlargement of the LA when compared with patients without HF; (b) patients with HFpEF are less likely to develop irreversible and severe fibrosis in the LA 29 ; (c) patients with HFpEF are not accompanied by a significant decrease in LVEF and fewer emergencies that occurred during procedure.…”
Background
Catheter ablation (CA) is an effective treatment for patients with atrial fibrillation (AF). The potential of CA to benefit AF patients with heart failure and preserved ejection fraction (HFpEF) is uncertain.
Hypothesis
CA may be safe and effective for patients with HFpEF.
Methods
The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies evaluating CA for AF patients with HFpEF.
Results
A total of seven trials with 1696 patients were included. Pooled analyses demonstrated similar procedure and fluoroscopy time regarding the use of CA for patients with HFpEF and without HF (weighted mean difference [WMD]: 0.40; 95% confidence interval (CI): −0.01–0.81,
p
= .05 and [WMD: 0.05; 95% CI: −0.18–0.28,
p
= .68]). Moreover, CA was effective in maintaining sinus rhythm (SR) in patients with HFpEF and noninferior for patients without HF [risk ratio (RR): 0.92; 95% CI: 0.76–1.10,
p
= .34). Additionally, CA tended to significantly maintain SR (RR: 4.73; 95% CI: 1.86–12.03,
p
= .001) and reduce rehospitalization for HF compared with medical therapy (RR: 0.36; 95% CI: 0.19–0.71,
p
= .003). However, no significant differences were found between two groups regarding the mortality rate (
p
= .59).
Conclusion
CA is a potential treatment strategy for patients with HFpEF and demonstrates equivalent efficacy to that of patients without HF. Moreover, the benefits of CA in maintaining SR and reducing rehospitalization of HF patients were significantly better than those of medical therapy. Additional randomized controlled trials are warranted to confirm our results.
“…A total of 5 studies were included in this review after screening and reviewing potentially relevant studies in detail ( Fig. 1 ) [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. Fig.…”
Background
This review aims to determine if patients who undergo atrial fibrillation (AF) ablation with heart failure with preserved ejection fraction (HFpEF) do better, or worse or the same compared to patients with heart failure with reduced ejection fraction (HFrEF).
Methods
A search of MEDLINE and EMBASE was performed using the search terms: “atrial fibrillation”, “ablation” and terms related to HFpEF and HFrEF in order to identify studies that evaluated one or more of i) AF recurrence, ii) periprocedural complications and iii) adverse outcomes at follow up for patients with HFpEF and HFrEF who underwent AF ablation. Data was extracted from included studies and statistically pooled to evaluate adverse events and AF recurrence.
Results
5 studies were included in this review and the sample size of the studies ranged from 91 to 521 patients with heart failure. There was no significant difference in the pooled rate for no AF or symptom recurrence after AF ablation comparing patients with HFpEF vs HFrEF (RR 1.07 95%CI 0.86–1.33, p = 0.15). The most common complications were access site complications/haematoma/bleeding which occurred in similar proportion in each group; HFpEF (3.1%) and HFrEF (3.1%). In terms of repeat ablations, two studies were pooled to yield a rate of 78/455 (17.1%) for HFpEF vs 24/279 (8.6%) for HFrEF (p = 0.001.
Conclusions
Heart failure patients with preserved or reduced ejection fraction have similar risk of AF or symptom recurrence after AF ablation but two studies suggest that patients with HFpEF are more likely to have repeat ablations.
“…In recent years, the incidence of heart failure has been increasing year by year. It is approximately 1.5% among adults, and that in the elderly people over 70 years old is even exceeding 11% [15]. Studies have proved that patients with atrial fibrillation are often accompanied by different degrees of heart failure.…”
The study focused on the application of speckle tracking algorithm in the segmentation of cardiac color ultrasound images of patients with atrial fibrillation combined with heart failure. First, the optical flow method and block matching method were introduced on the basis of multiphase level set algorithm. Then, the pyramid block matching method was applied to build a pyramid model from bottom to top according to each image, and thus a new segmentation algorithm of cardiac color ultrasound image was constructed. The speckle tracking algorithm based on the pyramid block matching method was applied to segment cardiac color ultrasound images of 136 patients with atrial fibrillation and heart failure and compared with the traditional diagnosis for the sensitivity, specificity, and accuracy. It was found that the curve smoothness and accuracy of the algorithm in this study were better than the traditional level set algorithm, and it made up for the shortcomings of the traditional method. The proportion of patients of class III-IV cardiac function was significantly higher than that of non-atrial fibrillation patients, and the difference was statistically significant (
P
<
0.05
); patients of classes III-IV showed better left ventricular ejection fraction (LVEF) (42.4 ± 2.8%), left ventricular end-diastolic diameter (LVED) (58.7 ± 7.4 mm), left ventricular end-systolic diameter (LVSD) (49.3 ± 5.6 mm), and left atrial inner diameter (LAD) (55.0 ± 1.4 mm) versus those of classes I-II, of whom the corresponding indexes were 58.8 ± 3.3%, 48.5 ± 5.9 mm, 33.5 ± 4.5 mm, and 45.2 ± 2.0 mm. The accuracy of diagnosis based on the algorithm of this study (93.22%) was significantly higher than that of traditional method (79.23%), and the differences were statistically significant (
P
<
0.05
). In conclusion, the algorithm in this study improves the segmentation accuracy and smoothness of the curve, which is suggested in clinic.
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