AB-452643-1 CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE WITH PRESERVED OR MILDLY REDUCED EJECTION FRACTION

Abstract

Evidence from randomized controlled trials is building for benefit of catheter atrial fibrillation (AF) ablation among heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), whereas data are still limited in HF patients with preserved or mildly reduced LVEF (HFpEF). To examine longitudinal variations in quality of life (QoL) and AF burden following AF ablation in HFpEF patients from a large patient-reported outcomes (PRO) database. All patients with HFpEF undergoing AF ablation (2013-2018) at Cleveland Clinic were included. HFpEF was defined as LVEF≥40% with clinical HF and/or HF admissions. Automated PRO surveys at baseline and 1-year post ablation were used to assess outcomes. QoL was measured via the AF symptom severity scale (AFSSS). AF burden was estimated using AF frequency and AF duration scores (Scale 0-9 for both). We enrolled a total of 813 consecutive patients, of which 609 (75%) were male and 562 (69%) had persistent AF. Mean±SD age, LVEF, and CHA2DS2VASc were 66±9y, 49.6±6.9%, and 3.3±1.6, respectively. Major periprocedural complications occurred in less than 2% of cases, with pericardial effusion being the most common (n=5, 0.6%). Freedom from AF recurrence at 1-year follow-up was 68%. After catheter AF ablation, patients either became asymptomatic or experienced an improvement of ≥1 AF-related symptoms in 81% of cases on average. Notably, the majority of patients experienced remarkable improvement in hallmark HFpEF symptoms, including fatigue, resting/exertional dyspnea and exercise intolerance. QoL was significantly improved from a baseline mean AFSSS of 12.8±9 to 6±6.5 at 1-year (p≤0.0001). AF burden was significantly decreased at 1-year, including frequency and duration of episodes (from a median of 9 to 0, p≤0.0001 for both). Catheter AF ablation was associated with a substantial improvement of QoL, AF burden, and pathognomonic HF symptoms in HF patients with preserved or mildly reduced EF.