56-05: Outcome of Catheter Ablation of Atrial Fibrillation in Patients with Latent Heart Failure and Preserved Left Ventricular Ejection Fraction

Abstract

Purpose: We investigated clinical outcome of catheter ablation for atrial fibrillation (AF) in patients with latent heart failure and preserved left ventricular ejection fraction (L-HFpEF). Methods: Echocardiography and direct measurement of the left atrial (LA) blood pressure were performed during radiofrequency catheter ablation in consecutive patients with non-valvular AF and left ventricular ejection fraction >50%. The LA pressure was measured at rest and during isometric handgrip exercise. All patients were followed for symptomatic AF recurrence for at least one year after ablation. Results: A total of 214 patients were included (age: 60 ±10, male: 66%, paroxysmal AF: 67%, LA volume index: 39 ± 11 ml/m2). L-HFpEF (LA mean pressure >15 mmHg at rest or during the exercise) occurred in 74 of the patients (34%). Factors associated with L-HFpEF are shown in the Table. AF recurred during 16 ± 6 months after ablation in 51% of the patients with L-HFpEF and in 33% of the controls (p = 0.01). In Cox regression analysis, after adjusting for the LA volume, AF type, body mass index, and the use of antiarrhythmic drugs, L-HFpEF independently predicted the AF recurrence (HR [95% CI] = 1.9 [1.1 to 3.1]). Conclusion: L-HFpEF is common in the patients with non-valuvular AF. Presence of L-HFpEF is associated with extensive LA remodelling and dysfunction, and it independently predicts worse outcome of catheter ablation for AF. Future studies have to clarify, whether these patients would benefit from a different strategy of ablation or post-procedural management.