Evaluating the Impact of Catheter Ablation on Cardiovascular and Cerebral Outcomes in Atrial Fibrillation With Heart Failure and Preserved Ejection Fraction.

POSTER PRESENTATIONS

Section 11: Evaluation and Management of Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction

IntroductionSodium–glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular death and heart failure hospitalization in patients suffering from heart failure with reduced ejection fraction (HFrEF). Recent trials suggest prognostic benefit in HF...

Catheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear. We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research. The comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12-1.51, P = 0.19), (HR: 0.78; 95% CI: 0.48-1.27, P = 0.31), and (OR: 1.10; 95% CI: 0.83-1.44, P = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99-11.54, P < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, P =0.47), (OR: 0.97; 95% CI: 0.50-1.86, P = 0.93), (OR: 1.27; 95% CI: 0.47-3.41, P = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; P = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; P = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; P = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; P = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; P = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; P = 0.38)]. This meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF. https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).

Background Although catheter ablation of atrial fibrillation (AF) has recently been shown to improve the cardiac function and even mortality in patients with heart failure (HF) and reduced ejection fraction (HFrEF), few studies have examined the outcomes of AF catheter ablation in patients with HF with preserved ejection fraction (HFpEF). Purpose To verify the impact of AF catheter ablation on the cardiac function and HF status in patients with HFpEF. Methods We studied 306 patients with HF who had a history of an HF hospitalization and/or preprocedural serum BNP levels &amp;gt;100pg/ml (age, 68.9±8.2 years old; male, 66.3%; non-paroxysmal AF, 63.1%, left atrial diameter [LAD], 42.5±6.3 mm; left ventricular ejection fraction [LVEF], 60.6±12.0%) out of 596 consecutive patients who underwent pulmonary vein isolation-based catheter ablation of AF. The patients with an LVEF ≥50% were defined as having HFpEF (n=262; age, 69.0±8.2 years old; male, 64.5%; non-paroxysmal AF, 61.8%, LAD, 42.1±5.9 mm; left LVEF, 64.0±8.2%) and the remaining patients with an LVEF &amp;lt;50% were defined as having HFrEF (n=44, age, 67.9±8.7 years old; male, 77.0%; non-paroxysmal AF, 70.5%, LAD, 44.9±8.2 mm; LVEF, 40.1±10.2%). The patients received periodic follow-ups for 12 months after the catheter ablation. The cardiac function parameters including the echocardiographic findings and HF functional status of the patients were compared between baseline and 12 months, stratified by the HF subgroup. Results AF recurred in 60 patients with HFpEF (22.9%) and in 14 with HFrEF (31.8%) during the 12 month follow-up (p=0.27), however, sinus rhythm was maintained at 12 months in most of the patients (253 patients with HFpEF [96.6%] and 42 patients with HFrEF [95.5%]) (p=0.71). Figure 1 compares the changes in the cardiac function parameters and NYHA functional class from baseline to the 12-month follow-up stratified by the HF subgroup. Both the patients with HFpEF and HFrEF had significant improvements in the serum BNP levels, chest thorax ratio, and LVEF determined by echocardiography. LA reverse remodeling as shown by a significant reduction in the LAD was observed in both HF subgroups, however, the E/E', an index of the LV diastolic function, did not significantly change in either of the subgroups. Similar to the patients with HFrEF, an improvement in the NYHA functional class was seen in those with HFpEF. Conclusions Catheter ablation of AF may benefit patients with HFpEF as well as those with HFrEF. Sinus rhythm maintenance achieved by AF catheter ablation in patients with HFpEF may lead to LA reverse remodeling and a better LV systolic function, thereby improving the NYHA functional class. It is unclear whether changes in the LV diastolic function may contribute to this favorable process. Funding Acknowledgement Type of funding source: None

Catheter ablation is associated with reduced heart failure (HF) hospitalization and death in select patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). However, the benefit in patients with HF with preserved ejection fraction (HFpEF) is uncertain. To investigate whether catheter ablation for AF is associated with reduced HF-related outcomes according to HF phenotype. A systematic search of MEDLINE, Embase, and Cochrane Central was conducted among studies published from inception to September 2023. Parallel-group randomized clinical trials (RCTs) comparing catheter ablation with conventional rate or rhythm control therapies in patients with HF, New York Heart Association functional class II or greater, and a history of paroxysmal or persistent AF were included. Pairs of independent reviewers screened 7531 titles and abstracts, of which 12 RCTs and 4 substudies met selection criteria. Data were abstracted in duplicate according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled effect estimates were calculated using random-effects Mantel-Haenszel models. Interaction P values were used to test for subgroup differences. The primary outcome was HF events, defined as HF hospitalization, clinically significant worsening of HF, or unscheduled visits to a clinician for treatment intensification. Secondary outcomes included cardiovascular and all-cause mortality. A total of 12 RCTs with 2465 participants (mean [SD] age, 65.3 [9.7] years; 658 females [26.7%]) were included; there were 1552 participants with HFrEF and 913 participants with HFpEF. Compared with conventional rate or rhythm control, catheter ablation was associated with reduced risk of HF events in HFrEF (risk ratio [RR], 0.59; 95% CI, 0.48-0.72), while there was no benefit in patients with HFpEF (RR, 0.93; 95% CI, 0.65-1.32) (P for interaction = .03). Catheter ablation was associated with reduced risk of cardiovascular death compared with conventional therapies in HFrEF (RR, 0.49; 95% CI, 0.34-0.70) but a differential association was not detected in HFpEF (RR, 0.91; 95% CI, 0.46-1.79) (P for interaction = .12). Similarly, no difference in the association of catheter ablation with all-cause mortality was found between HFrEF (RR vs conventional therapies, 0.63; 95% CI, 0.47-0.86) and HFpEF (RR vs conventional therapies, 0.95; 95% CI, 0.39-2.30) groups (P for interaction = .39). This study found that catheter ablation for AF was associated with reduced risk of HF events in patients with HFrEF but had limited or no benefit in HFpEF. Results from ongoing trials may further elucidate the role of catheter ablation for AF in HFpEF.

Sex differences have the potential to impact diagnostic and therapeutic interventions in a wide variety of medical conditions, and cardiac arrhythmias are no exception.1 Studies evaluating pathophysiology, disease course, and therapeutic options for cardiac arrhythmias have been performed predominantly in male patients. However, catheter and device-based therapies coupled with landmark clinical trials have contributed to an improved understanding of this important aspect. The objective of this review is to present the current state of knowledge on sex differences in cardiac arrhythmias with a focus on clinical management, while highlighting gaps in knowledge that would benefit from future investigation. ### Atrial Fibrillation and Atrial Flutter #### Disease Burden Atrial fibrillation (AF) and atrial flutter (AFL) are the most commonly encountered tachyarrhythmias in clinical practice, with significant implications for public health and healthcare costs. Stroke, hospitalization, and loss of productivity are the major consequences of AF.2 The incidence of AF (per 1000 person-years) is reported to be between 1.6 and 2.7 in women and between 3.8 and 4.7 in men.2 The age-adjusted incidence and prevalence of AF is lower in women compared with that in men, and accordingly, the lifetime risk of AF from the Framingham Heart Study at 40 years of age was higher in men (26.0% for men versus 23.0% for women).3 Another analysis from the Framingham Heart Study demonstrated no significant sex differences in the risk of developing AFL.4 The prevalence of AF continues to rise among both men and women. In a study investigating the global burden of disease from 1980 to 2010, there was not only an increase in overall burden, incidence, and prevalence of AF, but most importantly an increase in AF-associated mortality in both men and women (Figure 1).5 The age-adjusted mortality for women was consistently higher compared with that for men from 1990 to 2010 (Figure …

Research Needs and Priorities for Catheter Ablation of Atrial Fibrillation

The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated. This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction. Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke. In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group. AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.

Patients with atrial fibrillation (AF) require anticoagulation therapy when at least two clinical risk factors for stroke or thromboembolism are present, as defined in the CHA2DS2-VASc score.1 In this score the C stands for 'congestive heart failure' and nowadays the criteria to qualify for a C in clinical practice are more or less synonymous to the presence of signs/symptoms of heart failure.1 The criteria for the CHA2DS2-VASc score were, however, defined and developed at a time when heart failure was more or less restricted to patients who had left ventricular systolic dysfunction [or reduced left ventricular ejection fraction (LVEF)]. Whether these criteria also apply to patients who have heart failure with preserved ejection fraction (HFpEF), i.e. whether the C in the CHA2DS2-VASc score also 'counts' in this population, is however unknown.2 This is of interest as an increasing proportion of patients with heart failure have HFpEF, AF is more common in HFpEF and these patients have a similar increased risk for stroke or cardiovascular events.3-5 Diagnosing HFpEF has been increasingly important but remains challenging as compared to diagnosing a heart failure with a reduced ejection fraction (HFrEF). This viewpoint will focus on the history of the C in the CHA2DS2-VASc score and why it may or may not be considered to extrapolate the CHA2DS2-VASc criteria to patients with HFpEF and AF as well. In patients with AF, who have a CHA2DS2-VASc risk score of ≥2 (points) in men, and ≥3 (points) in women, anticoagulation therapy is generally recommended (class IA recommendation in the European Society of Cardiology AF management guidelines).1 The clinical characteristics from which the CHA2DS2-VASc score is derived are, however, all based on registry data.6 This is important to realize, since the definition for heart failure has evolved over recent years.3 First, the term generally used nowadays is no longer 'congestive' heart failure, but rather 'chronic' heart failure, which is related to the fact that not all patients have obvious signs of congestion and also the distinction is primarily made between acute and chronic heart failure. Second, and more importantly, since 2016 heart failure is categorized into three groups based on LVEF: reduced (<40%), mid-range (40–49%) and preserved (>50%). In the first description of the CHADS2 score, the precursor of the CHA2DS2-VASc score, the C was classified as recent (i.e. in the last 100 days in one of the studies7) congestive heart failure exacerbation (without a LVEF criterium).8 The CHA2DS2-VASc score is based on the CHADS2 score and uses the same definitions. In the first paper by Lip et al.6 proposing the CHA2DS2-VASc score, the Euro Heart Survey was used as a validation cohort, where congestive heart failure was classified as 'heart failure' or 'left ventricular ejection below 35%'. The group 'heart failure' in that study is possibly reflecting patients with symptoms of heart failure, with and without reduced ejection fraction, so it may be suggested that also HFpEF patients were included, although these data are not reported. The CHADS2 and CHA2DS2-VASc scores were not the first (and not the last) attempts for a reliable stroke prediction risk score in AF.9 The CHADS2 score was the result of previous risk scoring models, namely the Atrial Fibrillation Investigators (AFI) scheme and the Stroke Prevention and Atrial Fibrillation (SPAF) scheme.7 In the AFI risk scheme, data were collected from five other trials: (i) the Atrial Fibrillation, Aspirin, Anticoagulation Study from Copenhagen, Denmark (AFASAK), (ii) the Stroke Prevention in Atrial Fibrillation (SPAF) study, (iii) the Boston Area Anticoagulation Trial in Atrial Fibrillation (BAATAF), (iv) the Canadian Atrial Fibrillation Anticoagulation (CAFA) study, and (v) the Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation (SPINAF) study. Congestive heart failure was considered as a risk factor, but was not qualified similarly amongst the studies (see Table 1 for an overview of the studies). For example, in the AFASAK trial only patients with symptomatic moderate and severe heart failure were considered to have congestive heart failure.10 Notably, no data on LVEF were provided in any of these trials and it is uncertain what type of heart failure these patients really had (reduced, mid ranged or preserved LVEF). It appears, however, that from a historical perspective, many of these patients must have been HFrEF patients.3 In conclusion, in the original cohorts, predominantly HFrEF patients were included as HFpEF was not acknowledged at that time. Therefore, the C of congestive heart failure, appears to be primarily driven by HFrEF. For HFpEF and HFrEF the same pathophysiology processes are contributing to Virchow's pre-requisites for thrombosis: abnormal blood flow, abnormalities in the blood vessel wall, and abnormal blood constituents (Figure 1).11, 12 Constituent abnormalities are present in the form of abnormal platelets and increased levels of pro-thrombotic markers.11 While the level of many circulating biomarkers increases with severity or worsening of heart failure, as is the case for e.g. the level of plasminogen activator inhibitor and tissue plasminogen activator antigen, both markers of fibrinolysis are elevated in heart failure patients across a wide range of LVEF, and regardless of LVEF.11, 13 The risk of stroke is significantly increased in patients with any reduction in LVEF and increases with a high CHA2DS2-VASc score.14 The influence of LVEF on stroke risk appears to be substantial.13, 15 Recent data, however, suggest that the stroke risk is similarly increased in patients with reduced and preserved LVEF.16 A sub-analysis of patients (from the non-oral anticoagulation arm) participating in the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) trials who also had heart failure were categorized as having preserved vs. reduced ejection fraction.16 Data from this study showed that the stroke risk was comparable between the two groups: 4.3% (in patients with HFpEF) and 4.4% (in HFrEF) per 100 person-years.16 In addition, a meta-analysis incorporating seven studies with a total of 33 773 patients with heart failure showed that for patients with HFrEF and HFpEF who also had AF the rate of stroke risk was similar at 1.6% in HFrEF and 1.3% in HFpEF (relative risk 0.85, P = 0.094).15 The most recent AF guidelines do not further differentiate the C (congestive heart failure) in the CHA2DS2-VASc score, and score the 'C' when patients have signs/symptoms of heart failure or objective evidence of reduced LVEF. Indeed, there is no mention of HFpEF with regard to stroke prevention and as a result patients with HFpEF possibly must have more symptoms to receive anticoagulation (since they do not qualify with the LVEF criterium) than those with HFrEF. In the most recent heart failure guidelines it is stated that patients with heart failure (non-specified) and in New York Heart Association (NYHA) functional class II–IV should be considered for anticoagulation, if eligible, as assessed by the CHA2DS2-VASc score. Data on efficacy and safety of anticoagulation in heart failure patients have been published in several post-hoc analyses of the landmark novel oral anticoagulant (NOAC) trials.17-19 In the heart failure substudy of the ROCKET-AF trial, heart failure was defined as a history of heart failure (non-specified) or a LVEF <40%.17 In the ARISTOTLE heart failure substudy, two groups of heart failure were defined. Patients with left ventricular systolic dysfunction (defined as LVEF <40%, or a documentation of moderate or severe left ventricular systolic dysfunction) with or without symptomatic heart failure. Or the second group which were heart failure patients who had symptomatic heart failure and LVEF >40%, normal left ventricular function, or mild left ventricular systolic dysfunction, grouped as HFpEF.18 In the RE-LY trial, heart failure was defined as the presence of NYHA class II or higher in the 6 months before screening, in patients with a history of previous admission for congestive heart failure. Information about LVEF was available in only 2889 patients with heart failure (58.9%).19 A total 43.5% of the heart failure patients had a LVEF <40%, which may suggest that 56.5% of patients in the RE-LY heart failure group had HFpEF (or that no measurement was available). In the ENGAGE AF-TIMI 48 study, heart failure was defined as current presence or history of heart failure class C or D according to the American Heart Association/American College of Cardiology definition. In this study, 49% of patients had LVEF <50%, implying that half of the heart failure patients were HFpEF (of which many were classified as severe heart failure).20 Figure 2 shows the percentages of stroke in the heart failure groups and illustrates that in the heart failure population a significant proportion of patients had HFpEF. Overall the conclusions of these post-hoc NOAC papers were that the effect of NOACs in patients with heart failure and AF is similar, both for efficacy as well as for safety outcomes as compared to AF patients without heart failure. Although one should be cautious to draw strong conclusions from the above studies in patients with HFpEF, these recommendations have in fact been made (from the historical data) for patients with HFrEF. 17-20 Given the recent increase in HFpEF and the fact that the CHA2DS2-VASc is (mainly) based on HFrEF, criteria for anticoagulation for AF and HFpEF are in reality lacking. This is remarkable, given the fact that AF is more common in patients with HFpEF. However, as long as there are no trials performed specifically in this HFpEF population and there is no pathophysiological reason why data would be different in HFpEF, we believe that given the available data, anticoagulation must be seriously considered in many patients with AF and HFpEF. Indeed, recommendations for anticoagulation in AF/HFpEF patients may possibly be similar to those for HFrEF. Conflict of interest: none declared.

Do Existing Definitions Identify Subgroup Phenotypes or Reflect the Natural History of Heart Failure With Preserved Ejection Fraction?

AimsData regarding prognostic events following catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) are scarce. We conducted this study to compare the incidence of major adverse clinical events (MACE) following CA for AF between patients with HFpEF and those with systolic heart failure (HF).Methods and resultsThis single‐centre observational study included 142 patients with HF who underwent CA for AF (median follow‐up: 4.0 [2.6, 6.3] years). The patients were grouped based on the presence of HFpEF (n = 84) and systolic HF (left ventricular ejection fraction <50%, n = 58). We compared the cumulative incidence and incidence rate of MACE, comprising all‐cause death, unplanned cardiovascular hospitalization (CVH), and HF hospitalization (HFH) between both groups and the number of HFH before and after CA in each group. Multivariate analysis was performed to identify the predictors of MACE in patients with HFpEF. The incidence of MACE was comparable between the groups (following the first procedure: HFpEF: 23%, 4.7/100 person‐years, vs. systolic HF: 28%, 6.6/100 person‐years, P = 0.18; last procedure: 20%, 4.8/100 person‐years, vs. 24%, 6.9/100 person‐years, P = 0.21). Although the incidence of HFH was lower in patients with HFpEF than in those with systolic HF (first procedure: 14%, 2.9/100 person‐years, vs. 24%, 5.7/100 person‐years, P = 0.07; last procedure: 11%, 2.5/100 person‐years, vs. 24%, 6.9/100 person‐years, P = 0.01), the incidence of CVH was higher (first procedure: 8%, 1.7/100 person‐years, vs. 5%, 1.2/100 person‐years, P = 0.74; last procedure: 6%, 1.4/100 person‐years, vs. 2%, 0.5/100 person‐years, P = 0.4). The number of HFH significantly decreased in both groups after CA (HFpEF: 1 hospitalization [the first and third quartiles: 0, 1] in pre‐CA, vs. 0 hospitalizations [0, 0] in post‐CA, P < 0.0001; systolic HF: 1 hospitalization [0, 1], vs. 0 hospitalizations [0, 0], P < 0.005). The proportion of HFH among total clinical events was significantly smaller in patients with HFpEF than in those with systolic HF (following the first procedure: 56% vs. 88%, P < 0.005; last procedure: 52% vs. 92%, P < 0.005).ConclusionsCA for AF could be beneficial for patients with HFpEF, similar to those with systolic HF. However, clinical events other than HFH should be considered cautiously in such patients.

Atrial fibrillation (AF) ablation is Class I recommendation in selected heart failure (HF) patients with reduced ejection fraction; less is known in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to investigate the effects of AF ablation in patients with HFpEF. The CABANA (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial randomized patients with cardiovascular risk factors for stroke to AF ablation vs drug therapy. The presence of a high likelihood of HFpEF at enrollment was determined by a modified H2FPEF score of≥6. Treatment effects of baseline HFpEF likelihood on the AF ablation for death and cardiovascular admission, AF recurrence, and functional status were assessed. A total of 1,763 patients were included in the analysis. A high modified H2FPEF score (55% of the entire cohort) resulted in a significant treatment effect modulation (P for interaction=0.027), with a lower risk for cardiovascular hospitalization or death in patients with a high likelihood of HFpEF (HR: 0.82 [95%CI: 0.69-0.98]; P = 0.025), but not in patients without (HR: 1.00 [95%CI: 0.82-1.22]; P = 0.987). Although patients with a high likelihood of HFpEF were at a higher risk for AF recurrence, the greatest treatment effect of AF ablation on AF recurrence was observed in patients with a high likelihood of HFpEF (P for interaction=0.035). In a sensitivity analysis in a subset of patients with echocardiographic evidence of HFpEF (n=225), a similar treatment interaction was found. In patients undergoing AF ablation, the presence of underlying HFpEF (either by HFpEF probability ordefined by echocardiography) was associated with a larger benefit with AF ablation on clinical outcome, AF recurrence,and functional status. (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation [CABANA];NCT00911508).

We aimed to examine the benefits of catheter ablation in patients with non-paroxysmal atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. From 1173 consecutive patients undergoing catheter ablation, 502 with non-paroxysmal AF were divided into three groups: no history of HF [plasma B-type natriuretic peptide (BNP) <100 pg/mL and no HF hospitalization; n = 125], HFpEF [left ventricular (LV) EF ≥50%; n = 293], and HF with midrange EF (HFmrEF) + HFrEF (LVEF <50%; n = 84) groups. The endpoints were AF recurrence at 1 year, changes in symptomatic and image-based functional status, and changes in BNP levels from baseline to 1 year. In the HFpEF group, AF recurred in 48 patients (16.4%) and 278 patients (94.8%) had sinus rhythm at 1 year; these values were comparable with those in the other groups. Significant improvement was observed in the left atrial diameter, LVEF, and New York Heart Association functional class in the HFpEF and HFmrEF + HFrEF groups. The BNP level significantly decreased irrespective of the index rate control status, and freedom from AF recurrence was an independent predictor of HF remission, defined as BNP <100 pg/mL at 1 year, in the HFpEF group. Catheter ablation is highly feasible for restoring sinus rhythm in non-paroxysmal AF with coexisting HFpEF, thereby improving cardiac function and BNP levels. Catheter ablation for AF may be an optional management strategy.

Monitoring Is Key to Heart Failure in Elders