TY - JOUR
T1 - A prospective STudy using invAsive haemodynamic measurements foLLowing catheter ablation for AF and early HFpEF
T2 - STALL AF-HFpEF
AU - Sugumar, Hariharan
AU - Nanayakkara, Shane
AU - Vizi, Donna
AU - Wright, Leah
AU - Chieng, David
AU - Leet, Angeline
AU - Mariani, Justin A.
AU - Voskoboinik, Aleksandr
AU - Prabhu, Sandeep
AU - Taylor, Andrew J.
AU - Kalman, Jonathan M.
AU - Kistler, Peter M.
AU - Kaye, David M.
AU - Ling, Liang Han
N1 - Funding Information:
S.P. received grants for fellowship support from Boston Scientific and grants for fellowship support from Abbott, outside the submitted work. L.H.L. received grants from Abbott to support cost of investigations during the study. Abbott was not involved in the conception, conduct, data collection, data analysis or manuscript preparation. All other authors have nothing to disclose. Conflict of interest:
Publisher Copyright:
© 2021 European Society of Cardiology
PY - 2021/5
Y1 - 2021/5
N2 - Aims: The impact of atrial fibrillation (AF) ablation in early heart failure with preserved ejection fraction (HFpEF) is unknown. Our aim was to determine the impact of AF ablation on symptoms and exercise haemodynamic parameters of early HFpEF. Methods and results: Symptomatic AF patients referred for index AF ablation with ejection fraction ≥50% underwent baseline quality of life questionnaires, echocardiography, cardiac magnetic resonance imaging, exercise right heart catheterisation (exRHC), and brain natriuretic peptide (BNP) testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15 mmHg or peak exercise PCWP ≥25 mmHg. Patients with HFpEF were offered AF ablation and follow-up exRHC ≥6 months post-ablation. Of 54 patients undergoing baseline evaluation, 35 (65%) had HFpEF identified by exRHC. HFpEF patients were older (64 ± 10 vs. 54 ± 13 years, P < 0.01), and more frequently female (54% vs. 16%, P < 0.01), hypertensive (63% vs. 16%, P < 0.001), and suffering persistent AF (66% vs. 11%, P < 0.001), compared to those without HFpEF. Twenty HFpEF patients underwent AF ablation and follow-up exRHC 12 ± 6 months post-ablation. Nine (45%) patients no longer fulfilled exRHC criteria for HFpEF at follow-up. Patients remaining arrhythmia free (n = 9, 45%) showed significant improvements in peak exercise PCWP (29 ± 4 to 23 ± 2 mmHg, P < 0.01) and Minnesota Living with Heart Failure (MLHF) score (55 ± 30 to 22 ± 30, P < 0.01) while the remainder did not (PCWP 31 ± 5 to 30.0 ± 4 mmHg, P = NS; MLHF score 55 ± 23 to 25 ± 20, P = NS). Conclusion: Heart failure with preserved ejection fraction frequently coexists in patients with symptomatic AF and preserved ejection fraction. Restoration and maintenance of sinus rhythm in patients with comorbid AF and HFpEF improves haemodynamic parameters, BNP and symptoms associated with HFpEF.
AB - Aims: The impact of atrial fibrillation (AF) ablation in early heart failure with preserved ejection fraction (HFpEF) is unknown. Our aim was to determine the impact of AF ablation on symptoms and exercise haemodynamic parameters of early HFpEF. Methods and results: Symptomatic AF patients referred for index AF ablation with ejection fraction ≥50% underwent baseline quality of life questionnaires, echocardiography, cardiac magnetic resonance imaging, exercise right heart catheterisation (exRHC), and brain natriuretic peptide (BNP) testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15 mmHg or peak exercise PCWP ≥25 mmHg. Patients with HFpEF were offered AF ablation and follow-up exRHC ≥6 months post-ablation. Of 54 patients undergoing baseline evaluation, 35 (65%) had HFpEF identified by exRHC. HFpEF patients were older (64 ± 10 vs. 54 ± 13 years, P < 0.01), and more frequently female (54% vs. 16%, P < 0.01), hypertensive (63% vs. 16%, P < 0.001), and suffering persistent AF (66% vs. 11%, P < 0.001), compared to those without HFpEF. Twenty HFpEF patients underwent AF ablation and follow-up exRHC 12 ± 6 months post-ablation. Nine (45%) patients no longer fulfilled exRHC criteria for HFpEF at follow-up. Patients remaining arrhythmia free (n = 9, 45%) showed significant improvements in peak exercise PCWP (29 ± 4 to 23 ± 2 mmHg, P < 0.01) and Minnesota Living with Heart Failure (MLHF) score (55 ± 30 to 22 ± 30, P < 0.01) while the remainder did not (PCWP 31 ± 5 to 30.0 ± 4 mmHg, P = NS; MLHF score 55 ± 23 to 25 ± 20, P = NS). Conclusion: Heart failure with preserved ejection fraction frequently coexists in patients with symptomatic AF and preserved ejection fraction. Restoration and maintenance of sinus rhythm in patients with comorbid AF and HFpEF improves haemodynamic parameters, BNP and symptoms associated with HFpEF.
KW - Atrial fibrillation
KW - Exercise wedge pressure
KW - HFpEF
KW - Improvement
KW - Pulmonary capillary wedge pressure
KW - Reversal
KW - Sinus rhythm
UR - http://www.scopus.com/inward/record.url?scp=85102181526&partnerID=8YFLogxK
U2 - 10.1002/ejhf.2122
DO - 10.1002/ejhf.2122
M3 - Article
C2 - 33565197
AN - SCOPUS:85102181526
SN - 1388-9842
VL - 23
SP - 785
EP - 796
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 5
ER -