Atrial Fibrillation In Heart Failure Patients Research Articles

Effects of Heart Failure Therapies on Atrial Fibrillation: Biological and Clinical Perspectives.

Heart failure (HF) and atrial fibrillation (AF) are prevalent cardiovascular diseases that contribute significantly to morbidity, mortality, hospitalisation, and healthcare costs. It is not uncommon for these conditions to coexist and have mutually reinforcing effects. A critical factor in the aetiology of these conditions is oxidative stress, driven by reactive oxygen species (ROS), which contributes to atrial remodelling and fibrosis. The recent introduction of new drugs for the treatment of heart failure has also had an impact on the management of atrial fibrillation due to their influence on oxidative stress. The objective of this review is to analyse the effects of these therapies, including their role in mitigating ROS, on the prevention and treatment of AF in HF patients.

Incremental value of diastolic wall strain in predicting heart failure events in patients with atrial fibrillation.

Diastolic wall strain (DWS), an echocardiographic index based on linear elasticity theory, has been identified as a predictor of heart failure (HF) in patients with sinus rhythm. However, its effectiveness in atrial fibrillation (AF) patients remains uncertain. This study aims to assess DWS as a predictor of HF in AF patients with preserved ejection fraction. We analysed a prospective database of AF patients undergoing transthoracic echocardiography. AF patients with reduced left ventricular ejection fraction (< 50%), posterior wall motion abnormality, hypertrophic cardiomyopathy, valvular heart disease, pericardial disease, congenital heart disease, or history of pacemaker/implantable cardioverter-defibrillator implantation or cardiac surgery were excluded. The study followed patients until HF development, death, or last visit. Follow-up for patients who underwent catheter ablation was censored on the date of their procedure. HF was ascertained based on the Framingham criteria. DWS was calculated using a validated formula: DWS = (PWs -PWd)/PWs, where PWs is the posterior wall thickness at end-systole and PWd is the posterior wall thickness at end-diastole. Among 411 study patients (mean age 69.6 years, 66% men), 20 (5%) was underwent catheter ablation and 57 (14%) developed HF during a mean follow-up of 82 months. Cox-proportional hazards demonstrated that low DWS (≤ 0.33) significantly predicted HF events (hazard ratio [HR] 3.28, 95% confidence interval [CI]) 1.81-5.94, P < 0.0001), independent of age (per 10 years; HR 1.99, 95% CI 1.35-2.93, P < 0.001), indexed left ventricular mass (per 10g/m2; HR 1.16, 95% CI 1.05-1.27, P < 0.01), and indexed left atrial volume (per 10 mL/m2; HR 1.14, 95% CI 1.04-1.24, P < 0.01). Additionally, global log-likelihood ratio chi-square statistics indicated that DWS incrementally predicts HF development beyond age, indexed left ventricular mass, and left atrial volume (P < 0.001).

Increased Cyclic Guanosine Monophosphate and Interleukin-1Beta Is Activated by Mitochondrial Dysfunction and Associated With Heart Failure in Atrial Fibrillation Patients.

This study aimed to identify the association of cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator interferon genes (cGAS-STING) pathway with heart failure (HF) in atrial fibrillation (AF) patients. We prospectively enrolled 106 AF patients without evidence of HF. The serum levels of 2'3'-cyclic GMP-AMP (2'3'-cGAMP) and interleukin (IL)-1β were measured by enzyme-linked immunoassay (ELISA). To determine the underlying mechanism, we supplemented the complex I inhibitor rotenone and the specific cGAS inhibitor RU.521 in neonatal rat ventricular cardiomyocytes. During 18-month follow-up, serum concentrations of 2'3'-cGAMP (baseline 51.82 ± 11.34 pg/mL vs. follow-up 124.50 ± 75.83 pg/mL, Ppaired t < 0.01) and IL-1β (baseline 436.07 ± 165.82 vs. follow-up 632.48 ± 119.25 ng/mL, Ppaired t < 0.01) were substantially upregulated in AF patients with HF as compared with those without HF. Furthermore, serum 2'3'-cGAMP and IL-1β levels at 18-month follow-up were independently associated with the occurrence of HF in AF patients. Inhibition of cGAS by RU.521 effectively reversed the upregulation of 2'3'-cGAMP and STING phosphorylation induced by mitochondrial dysfunction, accompanied with inhibition of nod-like receptor protein 3 (NLRP3) inflammasome, IL-1β and IL-18 secretion. Induction of mitochondrial dysfunction causes an upregulation of 2'3'-cGAMP and activation of NLRP3 inflammasome through cGAS-STING pathway in cardiomyocytes.

Association of left atrial enlargement with heart failure events in non-valvular atrial fibrillation patients with preserved left ventricular ejection fraction.

Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little is known regarding the risk stratification for incident HF in AF patients, especially with preserved left ventricular ejection fraction (LVEF). The Fushimi AF Registry is a community-based prospective survey of AF patients. From the registry, 3002 non-valvular AF patients with preserved LVEF and with the data of antero-posterior left atrial diameter (LAD) at enrolment were investigated. Patients were stratified by LAD (<40, 40-44, 45-49, and ≥50 mm) with backgrounds and HF hospitalization incidences compared between groups. Of 3002 patients [mean age, 73.5 ± 10.7 years; women, 1226 (41%); paroxysmal AF, 1579 (53%); and mean CHA2DS2-VASc score, 3.3 ± 1.7], the mean LAD was 43 ± 8 mm. Patients with larger LAD were older and less often paroxysmal AF, with a higher CHA2DS2-VASc score (all P < 0.001). Heart failure hospitalization occurred in 412 patients during the median follow-up period of 6.0 years. Larger LAD was independently associated with a higher HF hospitalization risk [LAD ≥ 50 mm: hazard ratio (HR), 2.36; 95% confidence interval (CI), 1.75-3.18; LAD 45-49 mm: HR, 1.84; 95% CI, 1.37-2.46; and LAD 40-44 mm: HR, 1.34; 95% CI, 1.01-1.78, compared with LAD < 40 mm) after adjustment by age, sex, AF type, and CHA2DS2-VASc score. These results were also consistent across major subgroups, showing no significant interaction. Left atrial diameter is significantly associated with the risk of incident HF in AF patients with preserved LVEF, suggesting the utility of LAD regarding HF risk stratification for these patients.

Soluble ST2 and its relation to inflammatory, vascular atherosclerotic, and calcification markers in patients with atrial fibrillation or heart failure at moderate-to-high cardiovascular risk

Background: Cardiovascular diseases (CVDs) are the major cause of death globally. Among them, heart failure (HF) and atrial fibrillation (AF) result in poor prognosis and quality of life. Standard methods for assessing AF and HF, through history and physical examination, have limited sensitivity and specificity, which lead to delayed diagnosis and high risk of mortality. The identification of biomarkers able to detect the early stages of disease and/or their progression is of great importance for improving the clinical outcome. As AF and HF often coexist, it would be of great importance to find a biomarker with diagnostic utility in predicting HF in AF patients. Soluble suppression of tumorigenesis-2 (sST2) is a part of the cardioprotective IL-33/ST2 signaling pathway and may serve as a candidate biomarker for HF and AF. We aimed to evaluate sST2 serum levels in patients with AF and HF with preserved ejection fraction (HFpEF) and to explore potential relationships with traditional CVD risk factors and with novel biomarkers for vascular calcification such as undercarboxylated matrix Gla-protein (ucMGP). Materials and Methods: This study included 99 patients stratified into three groups: HFpEF (n=19), paroxysmal or persistent AF in sinus rhythm (n=33), and control group without CVD but at moderate-to-high CVD risk (n=47). Hemodynamic and anthropometric measures, coronary artery calcification (CAC), routine laboratory parameters, circulating ucMGP, and sST2 were measured. Results: sST2 levels were highly elevated in HFpEF patients. Significant positive correlation was found between sST2 and CAC-score (r=0.237, p=0.039), negative relations with serum lipids in AF patients, and positive association with serum C-reactive protein (r=0.609, p=0.018) in HFpEF patients. Soluble ST2 positively correlates with ucMGP in the entire studied population (r=0.252, p=0.006) and in the combined CVD group (AF+HFpEF) (r=0.254, p=0.036). Conclusions: sST2 levels emerge as a novel biomarker in CVD and may have prognostic importance for HF prediction in AF patients.

Abstract 12840: Left Atrial Enlargement is a Useful Predictor for Incident Heart Failure in Atrial Fibrillation Patients Without Pre-Existing Heart Failure

Background: Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the risk stratification for HF in AF patients. Hypothesis: Left atrial diameter (LAD) is a simple prognostic parameter in patients with HF. We hypothesized that LAD is a useful predictor for incident HF in AF patients even without pre-existing HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%), we investigated 2,464 patients with the data of LAD at enrollment. We divided the patients into 4 groups stratified by LAD (&lt;40 mm, 40-44 mm, 45-49 mm, and ≥50 mm), and compared the backgrounds and incidence of HF hospitalization between the groups. Results: Of 2,464 patients (mean age: 72±11 years, female: 919 [37%], paroxysmal AF: 1,405 [57%], and mean CHA2DS2-VASc score: 3.0±1.6), the mean LAD was 42±8 mm (&lt;40 mm: 1007 [41%], 40-44 mm: 650 [26%], 45-49 mm: 467 [19%] and ≥50 mm: 340 [14%], respectively). Patients with larger LAD had a higher prevalence of elderly and non-paroxysmal AF, and had a higher CHA2DS2-VASc score (all P&lt;0.001). During the median follow-up of 6.0 years, 260 patients (11%) were hospitalized for HF (annual incidence: 1.8% per person-year). Kaplan-Meier curves revealed that LAD was able to stratify the incidence of HF hospitalization in AF patients without HF (Figure). Multivariable Cox regression analysis demonstrated that larger LAD were independently associated with the risk of HF after adjustment by age, sex, AF type, and CHA2DS2-VASc score (Figure). Conclusion: Larger LAD was significantly associated with the higher incidence of HF hospitalization in AF without pre-existing HF, suggesting the utility of LAD regarding the risk stratification for HF in these patients.

Abstract 11995: Contemporary Guideline-Directed Medical Therapy (GDMT) for Heart Failure is Associated With A Reduced Incidence of New-Onset Atrial Fibrillation

Backgrounds: Heart Failure (HF) is a risk factor for new-onset atrial fibrillation (AF), and the new-onset AF is associated with a worse prognosis in HF patients. It has been reported that renin-angiotensin system inhibitor (RASi), β-blocker, mineral-corticoid receptor antagonist (MRA) and Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the new-onset AF in HF patients. However, significance of contemporary guideline-directed medical therapy (GDMT) for HF (RASi/ARNI + β-blocker + MRA + SGLT2i) on new-onset AF is unknown. We investigated the impact of GDMT for HF on new-onset AF. Methods and Results: We retrospectively studied the long-term (The mean follow-up was 603 ± 410 days) incidence of new-onset AF in HFrEF and HFmrEF patients without episode of AF (n=410) admitted to our hospital due to decompensated HF between 2015 and 2022. Patients were divided into 2 groups; patients treated with ≦2 HF drugs (n=192) and patients with ≧3 HF drugs (n=218) after discharge. The incidence of new-onset AF was significantly fewer in the ≧3 HF drugs group (HR 0.36, 95%CI 0.16-0.82). A multivariate analysis revealed that ≧3 HF drugs use was an independent negative predictor of new-onset AF (HR 0.38, 95%CI 0.15-0.98, P=0.04). Even after a propensity score matching of clinical variables, the incidence of new-onset AF was consistently fewer in the ≧3 HF drugs group (HR 0.39, 95%CI 0.15-1.00, P=0.04). Finally, comparing between patients with and without new-onset AF, new-onset AF was significantly associated with re-hospitalization for HF (HR 5.41, 95%CI 3.32-8.89, P&lt;0.001) and all-cause death (HR 2.36, 95%CI 0.98-5.68, P=0.047) in the studied population. Conclusion: The contemporary GDMT is associated with a reducing of new-onset AF in HF patients, which may be involved in the better outcomes with it.

Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: Current Evidence and Future Opportunities.

Atrial fibrillation (AF) and heart failure (HF) are highly prevalent cardiac disorders worldwide, and both are associated with poor prognosis. The incidence of AF and HF has been increasing substantially in recent years, mainly due to the progressive aging of the population. These disorders often coexist, and may have a causal relationship, with one contributing to the development or progression of the other. AF is a significant risk factor for adverse outcomes in HF patients, including mortality, hospitalization, and stroke. Although the optimal treatment for AF with HF remains unclear, catheter ablation (CA) has emerged as a promising treatment option. This review provides a comprehensive overview of the current scientific evidence regarding the efficacy of CA for managing AF in HF patients. In addition, the potential benefits and risks associated with CA are also discussed. We will also explore the factors that may influence treatment outcomes and highlight the remaining gaps in knowledge in this field.

Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis.

Optimal treatment regimen for patients with atrial fibrillation (AF) remains unclear. Therefore, the authors sought to compare the outcomes of ablation therapy versus pharmacological regimens in patients with AF. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials and observational studies comparing clinical outcomes between of ablation and pharmacological therapy in patients with AF. Stroke, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, heart failure (HF), and bleeding were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 % CIs. The analysis included ~200000 patients from 4 randomized controlled trials and 7 observational studies. Meta-analysis showed statistically significant reduction in stroke among patients on ablation therapy [hazard ratio (HR) 0.51, 95% CI (0.43, 0.60), P<0.00001, I2=10%], all-cause mortality [HR 0.64, 95% CI (0.45, 0.93), P=0.02, I2=58%], cardiovascular mortality [HR 0.35, 95% CI (0.25, 0.50), P<0.0001, I2=0%], and HF [HR 0.40, 95% CI (0.31, 0.53), P<0.00001, I2=30%]. However, no significant difference was revealed in the risk of cardiovascular hospitalization [HR 1.04, 95% CI (0.88, 1.23), P=0.66, I2=89%] and bleeding [HR 1.11, 95% CI (0.97, 1.27), P=0.13, I2=0%]. Ablation significantly reduces the risk of stroke, cardiovascular mortality, all-cause mortality, and HF in AF patients, compared with medical therapy alone, supporting its use in clinical practice.

Utility of left ventricular ejection fraction in atrial fibrillation patients without pre-existing heart failure.

Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus has been placed on the prevention of HF in patients with AF. Left ventricular ejection fraction (LVEF) is an established echocardiographic parameter in HF patients. We sought to investigate the association of LVEF with HF events in AF patients without pre-existing HF. The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. In this analysis, we excluded patients with pre-existing HF (defined as having one of the following: prior HF hospitalization, New York Heart Association class≥2 in association with heart disease, or LVEF<40%). Among 3233 AF patients without pre-existing HF, we investigated 2459 patients with the data of LVEF at enrolment. We divided the patients into three groups stratified by LVEF [mildly reduced LVEF (40-49%), below normal LVEF (50-59%), and normal LVEF (≥60%)] and compared the backgrounds and incidence of HF hospitalization between the groups. Of 2459 patients [mean age: 72.4±10.5years, female: 917 (37%), paroxysmal AF: 1405 (57%), and mean CHA2 DS2 -VASc score: 3.0±1.6], the mean LVEF was 66±8% [mildly reduced LVEF: 114 patients (5%), below normal LVEF: 300 patients (12%), and normal LVEF: 2045 patients (83%)]. Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P<0.01), but age and CHA2 DS2 -VASc score were comparable between the three groups (both P>0.05). During the median follow-up period of 6.0years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF [mildly reduced LVEF (40-49%): hazard ratio=2.98, 95% confidence interval=1.99-4.45 and below normal LVEF (50-59%): hazard ratio=2.01, 95% confidence interval=1.44-2.82, compared with normal LVEF (≥60%)] after adjustment by age, sex, type of AF, and CHA2 DS2 -VASc score. LVEF<60% was significantly associated with the higher risk of HF hospitalization across all major subgroups without significant interaction (P for interaction; all P>0.05). LVEF had an independent and incremental prognostic value for HF hospitalization in addition to natriuretic peptide levels in AF patients without pre-existing HF. Lower LVEF was significantly associated with the higher incidence of HF hospitalization in AF patients without pre-existing HF, leading to the future risk stratification for and prevention of incident HF in AF patients.

Abstract 10446: Prognostic Significance of Left Ventricular Ejection Fraction in Atrial Fibrillation Patients Without Pre-Existing Heart Failure

Introduction: Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the prevention of HF in patients with AF. Hypothesis: Left ventricular ejection fraction (LVEF) is an established echocardiographic parameters in patients with HF. We hypothesized that LVEF is a useful predictor for incident HF in AF patients even without HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. After excluding patients without pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or LVEF &lt;40%), we investigated 2,459 patients with the data of LVEF at enrollment. We divided the patients into 3 groups stratified by LVEF (mildly reduced LVEF [40-49%], below normal LVEF [50-59%], and normal LVEF [≥60%]), and compared the backgrounds and incidence of HF hospitalization between the groups. Results: Of 2,459 patients (mean age: 72.4±10.5 years, female: 917 [37%], paroxysmal AF: 1,405 [57%], and mean CHA 2 DS 2 -VASc score: 3.0±1.6), the mean LVEF was 66±8% (mildly reduced LVEF: 114 [5%], below normal LVEF: 300 [12%] and normal LVEF: 2,045 [83%], respectively). Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P&lt;0.01). During the median follow-up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Kaplan-Meier curves revealed that LVEF at enrollment could stratify the incidence of HF hospitalization in AF patients without pre-existing HF ( Figure ). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF after adjustment by age, sex, AF type and CHA 2 DS 2 -VASc score ( Figure ). Conclusion: LVEF at enrollment could stratify the incidence of HF hospitalization in patients with AF, suggesting the importance of measuring LVEF in all AF patients even without HF.

Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry.

To investigate the association between catheter ablation for atrial fibrillation (AF) and mortality as well as hospitalization for heart failure (HF) in patients with HF across the ejection fraction (EF) spectrum. Patients with first-time catheter ablation for AF (ablation group) compared to only medical treated AF patients (no ablation group) were identified from the Swedish Heart Failure Registry between 2005 and 2019. The primary outcome (all-cause mortality/first HF hospitalization) was assessed by Cox regression models in a 1:2 propensity score (PS) matched cohort and pre-specified EF subgroups (preserved EF [≥50%], mildly reduced EF [40-49%], reduced EF [&lt;40%]) of this cohort. A total of 452 patients in the ablation group and 43 766 patients in the no ablation group were identified. After PS matching, 434 patients in the ablation group were compared to 868 patients in the no ablation group. Over a median follow-up of 2.6 years (0.0-14.1 years), catheter ablation was associated with a lower risk of the primary outcome (all-cause mortality/first HF hospitalization) (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.65-0.94). Results were consistent across all EF subgroups. In HF with preserved EF (HFpEF), catheter ablation was also associated with a lower risk of recurrent HF hospitalization (incidence rate ratio 0.17, 95% CI 0.07-0.42). In HF patients across the EF spectrum, catheter ablation for AF was associated with lower risk of the primary outcome (all-cause mortality/first HF hospitalization). This study supports catheter ablation as a treatment option for AF in HF patients, including those with HFpEF.

Catheter ablation for patients with atrial fibrillation and heart failure: insights from the swedish heart failure registry

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG (Deutsche Forschungsgemeinschaft) to G.O. Aims To investigate the association between catheter ablation and mortality as well as hospitalization for heart failure (HF) in patients with atrial fibrillation (AF) and HF across the ejection fraction (EF) spectrum in a contemporary cohort. Methods Between 2005 and 2019, patients with first-time catheter ablation for AF (ablation group) compared to only medical treated AF patients (medical therapy group) were identified from the Swedish Heart Failure Registry. The primary outcome (all-cause mortality/first HF hospitalization) was assessed by cox regression models in a 1:2 propensity score (PS) matched cohort and pre-specified EF subgroups (preserved EF [HFpEF] [EF≥50%], mildly reduced EF [HFmrEF] [EF 40% to 49%], reduced EF [HFrEF] [EF&amp;lt;40%]) of this cohort. Results 452 patients in the ablation and 43766 patients in the medical therapy group were identified. After PS matching, 437 patients in the ablation group were compared to 874 patients in the medical therapy group. Over the entire follow-up, catheter ablation was associated with a lower risk of the primary outcome (Hazard ratio [HR] 0.71 [95%CI, 0.59-0.85]) and first cardiovascular (CV) hospitalization (HR 0.85 [95%CI, 0.72-0.99]) in PS matched analysis. Results were consistent across all EF subgroups. In HFpEF patients, catheter ablation was associated with a significantly lower risk of recurrent HF hospitalization (Incidence rate ratio (IRR) 0.17 [95%CI, 0.07-0.42]). Conclusion In this nationwide study, catheter ablation was associated with a significant lower risk of the primary outcome (all-cause mortality/first HF hospitalization) in HF patients with AF. This study advocates catheter ablation as a potent treatment option for AF in HF patients across all EF subgroups, including HFpEF.

The sST2 level is an independent influencing factor associated with atrial fibrillation in heart failure patients: a case-control study.

BackgroundMost heart failure (HF) patients were complicated with atrial fibrillation (AF). Previous study has reported a correlation between soluble suppression of tumorigenicity 2 (sST2) and HF. While the association between sST2 and AF in HF patients remains elusive, which will strengthen our understanding of sST2 in HF patients.MethodsIn the study, a case-control study was conducted with 306 HF patients enrolled from June 2019 to June 2020 at Beijing Anzhen Hospital. All the patients were divided into the following two groups, based on whether they AF complications prior to admission: (I) the HF group (patients with HF alone) and the HF-AF group (HF patients complicated with AF). Baseline data and sST2 levels were assessed and compared between the two groups, and the influencing factors associated with AF in HF patients were screened.ResultsThe sST2 level in the HF-AF group was 40.6 (25.9–53.6) ng/mL, which was significantly higher than that in the HF group [23.7 (16.3–35.9) ng/mL] (P<0.001). Correlation analysis showed that sST2 level in the HF-AF group was positively correlated with age (r=0.287, P=0.001), New York Heart Association (NYHA) grade (r=0.470, P<0.0001), left ventricular diameter (LVD) (r=0.311, P=0.001), serum creatinine (r=0.320, P<0.0001), NT-pro-brain natriuretic peptide (r=0.540, P<0.0001), and D-dimer (r=0.322, P<0.0001), and negatively correlated with left ventricular ejection fraction (LVEF) (r=−0.259, P=0.004), hemoglobin (r=−0.188, P=0.039), and glomerular filtration rate (r=−0.283, P=0.002). Logistic regression analysis results indicated that history of coronary heart disease [odds ratio (OR): 0.176, 95% confidence interval (CI): 0.081–0.380, P<0.0001], LVEF (OR: 0.956, 95% CI: 0.915–0.998, P=0.039), LVD (OR: 1.156, 95% CI: 1.059–1.261, P=0.001), left arterial diameter (OR: 0.761, 95% CI: 0.695–0.833, P<0.0001), and sST2 (OR: 0.942, 95% CI: 0.917–0.967, P<0.0001) were independent influencing factors associated with AF in HF patients.ConclusionsThe sST2 level is an independent influencing factor associated with AF in HF patients, which may favor to optimize the clinical strategies in the management of HF patients complicated with AF.

Beta-blocker treatment in heart failure patients with atrial fibrillation: challenges and perspectives.

Heart failure (HF) and atrial fibrillation (AF) are common conditions that share similar clinical phenotype and frequently coexist. The classification of HF in patients with preserved ejection fraction (> 50%, HFpEF), mid-range reduced EF (40%−49%, HFmrEF) and reduced EF (< 40%, HFrEF) are crucial for optimising the therapeutic approach, as each subgroup responds differently. Beta-blocker constitute an important component of our pharmacological regimen for chronic HF. Beta-blocker administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm, due to improvement of symptoms, the better long term-outcome and survival. The beneficial role of beta-blocker use in patients with preserved EF still remain unclear, as no treatment showed a positive impact, regarding morbidity or mortality reduction. The presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and mortality. But more question is the use of betablocker in HF patients irrespective of EF and concomitant AF. There are many conflicting data and publications, regarding the beta blocker benefit in this population. Generally, it is supported an attenuation of beta-blockers beneficial effect in HF patients with AF. A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of beta-blockers use and identify the patients with HF, who mostly profit from an invasive approach.

Outcomes of heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Recent randomized controlled trials have shown that in heart failure (HF) patients with reduced left ventricle ejection fraction (HFrEF) atrial fibrillation (AF) ablation reduces hospitalization and mortality due to HF compared to medical therapy (MT). However, only few studies have examined outcomes of catheter ablation (CA) for AF in HF patients with preserved left ventricle ejection fraction (HFpEF). Purpose. To compare the effect of catheter ablation on the outcomes of atrial fibrillation with chronic heart failure with preserved ejection fraction. Methods. Our prospective study included the main group (136 patients with the HFpEF who underwent a single procedure of the CA for symptomatic AF) and control group (58 patients with the HFpEF patients with paroxysmal or persistent AF on MT for rhythm and rate control strategy). To be eligible for inclusion for both groups, left ventricular diastolic dysfunction had to be present and/or relevant structural heart disease according to the current guidelines had to be fulfilled within 6 months prior to AF ablation. Outpatient follow-up were performed at 6, 12, 24 months intervals thereafter baseline. Results. At the follow-up the composite primary end point (all-cause death or worsening of HF that led to an unplanned hospitalization) appeared in significantly fewer patients in the CA group than in the MT group (18 (13,2%) patients vs. 16 (27,5%) patients; p =0,005). The secondary analyses showed there was 5 deaths in the CA group and 2 deaths in MT group, with rate of 3,7% and 3,4% respectively that were equal in comparable groups (p = 0,362). The incidences of HF hospitalization and cardiovascular hospitalization were also significantly higher in MT group than in CA group (14 (24,1%) vs. 13 (9,6%), p = 0,005) vs. 21 (15,4%), p = 0,016, respectively). Cardiovascular death and cerebrovascular accident were equal in comparable groups. The Kaplan–Meier curve for primary end-point demonstrated significant higher survival and freedom from hospitalizations due to HF in the CA group compared to MT group (p = 0,005); the freedom from hospitalization for worsening HF and the freedom from the cardiovascular hospitalization were having higher probability in the СA group (p = 0,003 and p= 0,016 ). Conclusion. Comparing catheter ablation with medical therapy for rhythm or rate control strategy in patients with heart failure with preserved left ventricle ejection fraction and atrial fibrillation, we found that catheter ablation was associated with lower rate of deaths and hospitalization due to worsening of heart failure.

IMPACT OF CHRONIC KIDNEY DISEASE ON HEART FAILURE SEVERITY IN HYPERTENSION AND ATRIAL FIBRILLATION PATIENTS

Objective: Given the frequent association of chronic kidney disease (CKD) to cardiovascular disorders and the coexistence of heart failure (HF) with atrial fibrillation (AF), especially in elderly, hypertension being a contributor, our main objective was to assess the effect of kidney dysfunction on the heart failure progression in hypertension and atrial fibrillation patients. Design and method: We conducted a retrospective analytic-observational study that included 258 AF patients, mean age 73.48 yr (SD = 10.4), 51.6% females. In order to classify the CKD, we divided the study population in two groups based on the estimated glomerular filtration rate (eGFR): higher or equal than 60, respectively below 60 ml/min/1.73 square meters, comparing the estimations of Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. We used the NYHA classification to identify the HF severity. Results: Of all patients, according to the presence or absence of the hypertension, 210 patients (81.4%) presented high blood pressure values. In terms of the eGFR using the MDRD equation, 117 patients presented a value higher or equal than 60 ml/min/1.73 square meters, while 93 had an eGFR below 60 ml/min/1.73 square meters. The median value of NYHA class was 3 in both groups (SD = 1.03; 0.96) and there was no statistical significance (p = 0.13) between them. By comparison, estimation using the CKD-EPI equation, indicated a statistically significant difference (p = 0.03), 109 patients presented higher than 60 ml/min/1.73 square meters and 101 patients were below this cut off value even though the median NYHA class was 3 as well (SD = 1.04; 0.94). Conclusions: These results reinforce the well-known superiority in the accuracy of the CKD-EPI equation. But, in terms of the influence of renal dysfunction severity on the heart failure severeness, our results suggest that decreasing in the eGFR is not correlated with the progression of the heart failure in AF patients. However, given the severity of complications and importance of proper treatment in atrial fibrillation, the development of an estimation equation that relates to the presence of atrial fibrillation should be considered.

Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients.

Introduction. Atrial fibrillation (AF) is the most frequent hospitalized arrhythmia. It associates increased risk of death, stroke and heart failure (HF). Stroke risk scores, especially CHA2DS2-VASc, have been applied also for populations with different diseases. There is, however, limited data focusing on the ability of these scores to predict HF decompensation.Methods. We conducted a retrospective observational study on a cohort of 204 patients admitted for cardiovascular pathology to the Cardiology Ward of our tertiary University Hospital. We aimed to determine whether the stroke risk scores could predict hospitalisations for acute decompensated HF in AF patients.Results. C-statistics for CHADS2 and R2CHADS2 showed a modest predictive ability for hospitalisation with decompensated HF (CHADS2: AUC 0.631 p = 0.003; 95%CI 0.560-0.697. R2CHADS2: AUC 0.619; 95%CI 0.548-0.686; p = 0.004), a marginal correlation for CHA2DS2-VASc (AUC 0.572 95%CI 0.501-0.641 with a p value of only 0.09, while the other scores failed to show a correlation. A CHADS2 ≥ 2 showed a RR = 2.96, p<0.0001 for decompensated HF compared to a score <2. For R2CHADS2 ≥ 2, RR = 2.41, p = 0.001 compared to a score <2. For CHA2DS2-VASc ≥ 2 RR = 2.18 p = 0.1, compared to CHA2DS2-VASc <2. The correlation coefficients showed a weak correlation for CHADS2 (r = 0.216; p = 0.001) and even weaker for R2CHADS2 (r = 0.197; p = 0.0047 and CHA2DS2-VASc (r = 0.14; p = 0.035).Conclusions. Among AF patients, CHADS2, CHA2DS2-VASc and R2CHADS2 were associated with the risk of hospitalisation for decompensated HF while ABC and ATRIA failed to show an association. However, predictive accuracy was modest and the clinical utility for this outcome remains to be determined.

Mutual relationship between heart failure and atrial fibrillation.

Atrial fibrillation (AF) and heart failure (HF) are evolving epidemies, together responsible for substantial human suffering and health-care expenditure. The simultaneous co-hexistence of the two conditions is associated with mortality rates higher than those observed in individuals with only one or none of them. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently if compared to those with HF or AF alone. These results highlight the clear clinical need to identify and treat these diseases according to best evidence, in order to prevent adverse outcomes and reduce the huge burden that HF and AF are expected to have on global healthcare systems in the future.

Comparison of Outcomes After Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Versus Reduced Ejection Fraction

Catheter ablation improves outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). We sought to evaluate the efficacy and safety of catheter ablation of AF in HF patients with a preserved ejection fraction (HFpEF). We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was recurrence of all atrial arrhythmias on or off antiarrhythmic drugs (AAD). Of 547 total patients, 51 (9.3%) had HFpEF, 40 (7.3%) had HFrEF, and 456 (83.4%) were without HF. There was no difference in recurrence of atrial arrhythmias on or off AAD (Adjusted Hazard Ratio [AHR] 1.92 [95% CI 0.97 to 3.83] for HFpEF vs HFrEF and AHR 0.90 [95% CI 0.59 to 1.39] for HFpEF vs no HF) or off AAD (AHR 1.96 [95% CI 0.99 to 3.90] for HFpEF vs HFrEF and AHR 1.14 [95% CI 0.74 to 1.77] for HFpEF vs no HF). There was also no difference in rates of all-cause hospitalizations (AHR 1.80 [95% CI 0.97 to 3.33] for HFpEF vs HFrEF and AHR 2.05 [95% CI 1.30 to 3.23] for HFpEF vs no HF) or rates of all-cause mortality (AHR 0.53 [95% CI 0.05 to 6.11] for HFpEF vs HFrEF and AHR 2.46 [95% CI 0.34 to 17.92] for HFpEF vs no HF). There were no significant differences in AAD use (p = 0.176) or procedural complications between groups (p = 0.980). In conclusion, there were no significant differences in arrhythmia-free survival between patients with HFpEF and HFrEF that underwent catheter ablation of AF.