Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is frequently complicated by atrial fibrillation (AF). Catheter ablation for AF is an effective method for restoring and maintaining sinus rhythm (SR). However, there is limited data on the serial changes in echocardiographic parameters in patients with HFpEF after ablation. Hypothesis: The serial changes in echocardiographic parameters after ablation for AF depend not only on baseline rhythm but also on the presence of HFpEF. Methods: A retrospectively review was conducted on 1109 out of 2123 patients who had serial echocardiographic data available before the ablation procedure and at 1-year, 2-year, and 3-year follow-ups. The changes in echocardiographic parameters were assessed using repeated measures ANOVA with a Greenhouse-Geisser correction and Bonferroni tests in four groups, which were divided according to baseline rhythm and HFpEF. HFpEF was defined as an HFA-PEFF score ≥ 5 or 2-4 and left atrial pressure ≥ 15 mmHg at the time of catheter ablation. Results: The prevalence of HFpEF was 51.9%, and paroxysmal AF was present in 65%. Left atrial volume index (LAVI) was larger at baseline in patients with AF and significant decreased after ablation in all groups. The trend of left atrial emptying fraction (LAEF) increased in patients with baseline AF until 1year later, while in patients with baseline SR and HFpEF, LAEF gradually declined even after catheter ablation. The trend of left ventricular ejection fraction increased in patients with baseline AF. The trend of mean E/E’ mildly increased after ablation in all groups. There were significant differences between HFpEF and non-HFpEF. (Figure) Conclusions: Catheter ablation was associated with changes of LA size, function and left ventricular function. Baseline rhythm and the presence of HFpEF play a complex role in the course of cardiac function after ablation.
Published Version
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