Abstract 380 Cryoballoon-Ablation of Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction

Aims: Co-existence of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) is common and severely affects morbidity and prognosis. This study evaluates outcome after cryoballoon-ablation for AF in patients with HFpEF compared to patients without heart failure employing multiple diagnostic modalities.

Methods: A total of 102 patients scheduled for cryoablation of AF with left ventricular ejection fraction ≥50% were prospectively enrolled. Baseline evaluation included echocardiography, stress echocardiography, six-minute-walk-test, biomarker measurements and quality of life assessment (SF-36). HFpEF was diagnosed in a subgroup of patients based on clinical and echocardiographic and biomarker characteristics according to current guidelines. Diagnosis was confirmed by application of HFA-PEFF-Score. Procedural parameters and clinical, functional and echocardiographic endpoints at follow-up ≥12 months after AF-ablation were compared between patients with and without HFpEF.

Results: Patients with HFpEF (n=24) were older (median: 73.5 years [Q₂₅: 66.5 years; Q₇₅: 75.8 years] vs. 64.5 years [Q₂₅: 55.0 years; Q₇₅: 71.3 years], P<0.001) and more often female (83.3% vs. 28.2%). They were characterized by more pronounced AF-related symptoms (median EHRA-score: 3.0 [Q₂₅:3.0; Q₇₅:3.0] vs. 2.0 [Q₂₅: 2.0; Q₇₅: 3.0], P<0.001), reduced left atrial (LA)-appendage velocity in preprocedural transoesophageal echocardiography (median: 35.5cm/s [Q₂₅: 26.5 cm/s; Q₇₅: 54.8 cm/s] vs. 59.0 cm/s [Q₂₅: 37.0 cm/s; Q₇₅: 80.0 cm/s], P<0.001), reduced distance in six-minute-walk-test (median: 487.5 m [Q₂₅: 378.1 m; Q₇₅: 517.8 m] vs. 539.0 m [Q₂₅: 489.3 m; Q₇₅: 589.1 m], P<0.001), and higher mean LA-pressure measured at the needle tip after transseptal puncture (median: 14.0 mmHg [Q₂₅: 10.3 mmHg; Q₇₅: 21.5 mmHg] vs.10.0 mmHg [Q₂₅: 8.0 mmHg; Q₇₅: 13.3 mmHg], P=0.008). Procedural parameters were comparable between the two subgroups. Rates of AF-recurrence, repeat AF-ablation and AF-related re-hospitalization were increased in HFpEF (Figure 1), which was confirmed after adjusting for intergroup differences in sex and age distribution by multiple regression analysis. There was no improvement of heart failure-related symptoms and persistent elevation of cardiac biomarkers, even in HFpEF-patients with successful restoration of sinus rhythm at follow-up (Figure 2). Echocardiographic follow-up showed progression of adverse LA-remodeling (median LA-volume index at baseline: 35.8 ml/m² [Q₂₅: 32.2 ml/m²; Q₇₅: 41.9 ml/m²] vs. 12-month follow-up: 40.5 ml/m² [Q₂₅: 36.0 ml/m²; Q₇₅: 51.4 ml/m²], P=0.017) and no improvement in diastolic function in HFpEF (median E/e’ at baseline: 9.7 [Q₂₅: 7.8; Q₇₅: 12.1] vs 12-month follow-up: 10.2 [Q₂₅: 8.4; Q₇₅: 11.8], P=0.874), in particular in patients with HFpEF and AF-recurrence. Quality of life improved in patients without HFpEF in both physical and mental summary scales, however, no beneficial effect was seen in HFpEF.

Conclusion: Patients with HFpEF constitute a distinct subgroup with an elevated risk for arrhythmia recurrence after cryoablation of AF. Functional hallmarks and heart-failure related symptoms of HFpEF persist, irrespective of rhythm-status at follow-up. Future research is needed to optimize tailored treatment strategies in HFpEF-patients, taking into account the underlying structural cardiac disease and associated risk factors.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Cryoballoon-Ablation of Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction
M. M. Zylla¹, J. Leiner², A.-K. Rahm¹, T. Hoffmann¹, P. Lugenbiel¹, P. Schweizer¹, E. P. Scholz³, D. Mereles¹, D. Kronsteiner⁴, M. Kieser⁴, H. A. Katus¹, N. Frey¹, D. Thomas¹
¹Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; ²Leipzig Heart Institute, Leipzig; ³Innere Medizin I, Kardiologie, GRN Klinik Schwetzingen gGmbH, Schwetzingen; ⁴Institut für Medizinische Biometrie, Heidelberg;
Aims: Co-existence of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) is common and severely affects morbidity and prognosis. This study evaluates outcome after cryoballoon-ablation for AF in patients with HFpEF compared to patients without heart failure employing multiple diagnostic modalities. Methods: A total of 102 patients scheduled for cryoablation of AF with left ventricular ejection fraction ≥50% were prospectively enrolled. Baseline evaluation included echocardiography, stress echocardiography, six-minute-walk-test, biomarker measurements and quality of life assessment (SF-36). HFpEF was diagnosed in a subgroup of patients based on clinical and echocardiographic and biomarker characteristics according to current guidelines. Diagnosis was confirmed by application of HFA-PEFF-Score. Procedural parameters and clinical, functional and echocardiographic endpoints at follow-up ≥12 months after AF-ablation were compared between patients with and without HFpEF. Results: Patients with HFpEF (n=24) were older (median: 73.5 years [Q₂₅: 66.5 years; Q₇₅: 75.8 years] vs. 64.5 years [Q₂₅: 55.0 years; Q₇₅: 71.3 years], P<0.001) and more often female (83.3% vs. 28.2%). They were characterized by more pronounced AF-related symptoms (median EHRA-score: 3.0 [Q₂₅:3.0; Q₇₅:3.0] vs. 2.0 [Q₂₅: 2.0; Q₇₅: 3.0], P<0.001), reduced left atrial (LA)-appendage velocity in preprocedural transoesophageal echocardiography (median: 35.5cm/s [Q₂₅: 26.5 cm/s; Q₇₅: 54.8 cm/s] vs. 59.0 cm/s [Q₂₅: 37.0 cm/s; Q₇₅: 80.0 cm/s], P<0.001), reduced distance in six-minute-walk-test (median: 487.5 m [Q₂₅: 378.1 m; Q₇₅: 517.8 m] vs. 539.0 m [Q₂₅: 489.3 m; Q₇₅: 589.1 m], P<0.001), and higher mean LA-pressure measured at the needle tip after transseptal puncture (median: 14.0 mmHg [Q₂₅: 10.3 mmHg; Q₇₅: 21.5 mmHg] vs.10.0 mmHg [Q₂₅: 8.0 mmHg; Q₇₅: 13.3 mmHg], P=0.008). Procedural parameters were comparable between the two subgroups. Rates of AF-recurrence, repeat AF-ablation and AF-related re-hospitalization were increased in HFpEF (Figure 1), which was confirmed after adjusting for intergroup differences in sex and age distribution by multiple regression analysis. There was no improvement of heart failure-related symptoms and persistent elevation of cardiac biomarkers, even in HFpEF-patients with successful restoration of sinus rhythm at follow-up (Figure 2). Echocardiographic follow-up showed progression of adverse LA-remodeling (median LA-volume index at baseline: 35.8 ml/m² [Q₂₅: 32.2 ml/m²; Q₇₅: 41.9 ml/m²] vs. 12-month follow-up: 40.5 ml/m² [Q₂₅: 36.0 ml/m²; Q₇₅: 51.4 ml/m²], P=0.017) and no improvement in diastolic function in HFpEF (median E/e’ at baseline: 9.7 [Q₂₅: 7.8; Q₇₅: 12.1] vs 12-month follow-up: 10.2 [Q₂₅: 8.4; Q₇₅: 11.8], P=0.874), in particular in patients with HFpEF and AF-recurrence. Quality of life improved in patients without HFpEF in both physical and mental summary scales, however, no beneficial effect was seen in HFpEF. Conclusion: Patients with HFpEF constitute a distinct subgroup with an elevated risk for arrhythmia recurrence after cryoablation of AF. Functional hallmarks and heart-failure related symptoms of HFpEF persist, irrespective of rhythm-status at follow-up. Future research is needed to optimize tailored treatment strategies in HFpEF-patients, taking into account the underlying structural cardiac disease and associated risk factors.
https://dgk.org/kongress_programme/jt2022/aP840.html