Clinical course of chronic heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation

T V Zolotarova ,М С Брынза

doi:10.26565/2313-6693-2020-40-14

Abstract

Introducrion. Recent randomized controlled trials suggest that catheter ablation of atrial fibrillation (AF) in heart failure (HF) patients leads to improvements in left ventricular function, exercise capacity, and quality of life, but focused on HF with reduced left ventricle ejection fraction (LVEF). Aim. To study the clinical course of chronic heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation. Materials and methods. 194 patients with AF and chronic HF with preserved ejection fraction were included in the study: 136 patients – underwent catheter ablation (CA) for AF; 58 − control group, who continued pharmacological therapy (PT) for rhythm control strategy. All the patients had New York Heart Association (NYHA) class I, II or III HF, LVEF > 40 %. Baseline characteristics comprised demographic and clinical data, medical history echocardiography and ECG results of the included patients. Results. Patients on PT were significantly more symptomatic for HF in comparison to CA patients (the average value of NYHA class HF 2,2 ± 07 versus (vs.) 1,8 ± 0,6; p = 0,019), but AF for itself were more symptomatic in CA group (the average value of EHRA 3,1 ± 0,5 vs. 2,9 ± 0,6; p = 0,001). Among patients with HF with preserved LVEF who underwent CA and were followed-up 24 months 52,9 % of patients remained free of AF recurrence; while in the control group only 7 %. At the 24 months follow-up NYHA class significantly improved in ablation group, as well as EHRA score. Conclusions. Radiofrequency catheter ablation was associated with improved the clinical course of chronic heart failure with preserved left ventricle ejection fraction and AF – related symptoms itself.

Highlights

Atrial fibrillation (AF) and heart failure (HF) are cardiovascular disease epidemics that have grown worldwide in the past 2 decades
The study population consisted of 136 patients with chronic HF (CHF) with preserved (> 40 %) left ventricle EF who underwent Radiofrequency catheter ablation (RFCA) for atrial fibrillation that was refractory to pharmacological therapy (PT) and 58 patients from the control group who continued PT for rhythm control strategy
194 patients with AF and CHF with pLVEF were included in this study

Summary

Introduction

Atrial fibrillation (AF) and heart failure (HF) are cardiovascular disease epidemics that have grown worldwide in the past 2 decades. HF with preserved left ventricle ejection fraction (HF pLVEF) accounts for ≈ 40 % to 50 % of incident HF overall and two-thirds of the patients may at some point have arrhythmia during the course of the disease. AF seems to implicate a worse prognosis in patients with HFpEF than HF with reduced EF. Rhythm control has been shown to achieve greater success in improving LV dysfunction with a resultant favorable impact on quality of life and survival. Radiofrequency catheter ablation (RFCA) is an effective rhythm control strategy for patients with AF, and it has become a standard procedure for anti-arrhythmic drug resistant AF in current guidelines for AF management [2]

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Conclusion