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Cheko J, Patsalis N, Kreutz J, Divchev D, Chatzis G, Schieffer B, Markus B. The Impact of Positive Inotropic Therapy on Hemodynamics and Organ Function in Acute Heart Failure: A Differentiated View. J Pers Med 2023; 14:17. [PMID: 38248718 PMCID: PMC10820131 DOI: 10.3390/jpm14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Little is known about the impact of treatment with inotropic drugs on the interaction of hemodynamics, biomarkers, and end-organ function in patients with acute decompensated heart failure (HF) of different origins and heart rhythms. METHODS Fifty patients with different causes of acute decompensated HF (dilated cardiomyopathy DCM, ischemic cardiomyopathy ICM, atrial fibrillation AF, sinus rhythm/pacemaker lead rhythm SR/PM) were treated with dobutamine or levosimendan. Non-invasive hemodynamics, biomarkers, and parameters of renal organ function were evaluated at hospital admission and after myocardial recompensation (day 5 to 7). RESULTS Twenty-seven patients with ICM and twenty-three patients with DCM were included. Thirty-nine patients were treated with dobutamine and eleven with levosimendan. Sixteen were accompanied by persistent AF and thirty-four presented either with SR or PM. In the overall cohort, body weight and biomarkers (NT-proBNP/ST2) significantly decreased. GFR significantly increased during therapy with either dobutamine or levosimendan. However, hemodynamic parameters seem to be only improved in patients with DCM, in the levosimendan sub-group, and in patients with SR/PM. CONCLUSION Patients with acute decompensated HF benefit from positive inotropic therapy during short-term follow-ups. In particular, patients with DCM, those after levosimendan therapy and those with SR/PM, seem to benefit most from inotropic therapy.
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Affiliation(s)
| | | | | | | | | | | | - Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, Hospital of the Phillips University of Marburg, D-35043 Marburg, Germany; (J.C.); (N.P.); (J.K.); (D.D.); (G.C.); (B.S.)
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2
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Budnik M, Gawałko M, Lodziński P, Tymińska A, Ozierański K, Grabowski M, Peller M, Wancerz A, Kiliszek M, Opolski G, Lenarczyk R, Kalarus Z, Lip GY, Balsam P. Heart failure in patients with atrial fibrillation: Insights from Polish part of the EORP-AF general long-term registry. ESC Heart Fail 2022; 10:637-649. [PMID: 36415165 PMCID: PMC9871703 DOI: 10.1002/ehf2.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
AIMS This study aimed to determine the impact of heart failure (HF) on clinical outcomes in patients with atrial fibrillation (AF). METHODS AND RESULTS We analysed data from Polish participants of the EURObservational Research Programme-AF General Long-Term Registry. The primary endpoint was all-cause death, and the secondary endpoints included hospital readmissions, cardiovascular (CV) interventions, thromboembolic and haemorrhagic events, rhythm control interventions, and other CV or non-CV diseases development during one-year follow up. Overall, 688 patients with available data on HF were included into analysis; 51% (n = 351) had HF; of these 48% (n = 168) had reduced ejection fraction (HFrEF), 22% (n = 77) mid-range EF (HFmrEF), and 30% (n = 106) preserved EF (HFpEF). Compared with patients without HF, those with HF had higher mortality rate (aHR 5.61; 95% CI 1.94-16.22, P < 0.01). Patients with HF (vs. without HF) had more often CV interventions (10% vs. 5.4%, P = 0.046) and events (14% vs. 7.1%, P = 0.02), and had less often atrial arrhythmia-related hospital admissions (6.8% vs. 15%, P < 0.01). Over follow-up, patients with HFmrEF and HFpEF had similar mortality rate versus HFrEF (aHR 0.45, 95% CI 0.13-1.57, P = 0.45 for HFmrEF and aHR 0.54, 95% CI 0.20-1.48, P = 0.54 for HFpEF). Mortality rate was similar among rhythm versus rate control group (aHR 0.34; 95% CI 0.10-1.16; P = 0.34). CONCLUSIONS AF patients with HF have greater mortality rate and more CV interventions/events. No statistically significant difference in long-term outcomes between patients with HFrEF, HFmrEF, and HFpEF highlights the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF.
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Affiliation(s)
- Monika Budnik
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Monika Gawałko
- First Department of CardiologyMedical University of WarsawWarsawPoland,Institute of Pharmacology, West German Heart and Vascular CentreUniversity Duisburg‐EssenDuisburgGermany,Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands
| | - Piotr Lodziński
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Agata Tymińska
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Marcin Grabowski
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Michał Peller
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Anna Wancerz
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Marek Kiliszek
- Department of Cardiology and Internal DiseasesMilitary Institute of MedicineWarsawPoland
| | - Grzegorz Opolski
- First Department of CardiologyMedical University of WarsawWarsawPoland
| | - Radosław Lenarczyk
- First Department of Cardiology and AngiologySilesian Centre for Heart DiseaseZabrzePoland
| | - Zbigniew Kalarus
- Department of Cardiology, DMS in ZabrzeMedical University of SilesiaKatowicePoland
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest HospitalUniversity of LiverpoolLiverpoolUK,Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Paweł Balsam
- First Department of CardiologyMedical University of WarsawWarsawPoland
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3
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Chen C, Cheng K, Gao X, Zou T, Pang Y, Ling Y, Xu Y, Xu Y, Chen Q, Zhu W, Ge J. Cryoballoon ablation for atrial fibrillation in patients with heart failure with mildly reduced and preserved ejection fraction. ESC Heart Fail 2022; 10:518-531. [PMID: 36325978 PMCID: PMC9871672 DOI: 10.1002/ehf2.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Limited data are available on the outcomes of cryoballoon ablation (CBA)-based pulmonary vein isolation (PVI) for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF). The present study aimed to evaluate the safety and effectiveness of CBA in such patients. METHODS AND RESULTS Consecutive patients with AF referred for CBA-based PVI from two highly experienced electrophysiology centres were included in this retrospective study. Of 651 patients undergoing CBA, 471 cases were divided into four groups: No HF (n = 255), HFpEF (n = 101), HFmrEF (n = 78), and HF with reduced ejection fraction (n = 37). Similar early recurrence of atrial arrhythmia was found among groups (16.2% vs. 15.4% vs. 14.9% vs. 12.2%, P = 0.798), and no significant difference of long-term sinus rhythm (SR) maintenance was identified among the HFmrEF, HFpEF, and No HF groups (71.8% vs. 75.2% vs. 79.6%, P = 0.334). CBA is safe for patients with HFmrEF and HFpEF with similar complications compared with the No HF group (3.8% vs. 4.0% vs. 3.1%, P = 0.814). The reassessment of cardiac function after CBA showed that patients with HF indicated beneficial outcomes. Left atrial diameter (LAD) and left ventricular ejection fraction were significantly improved in the HFmrEF group. There were 41.6% of patients in the HFpEF group who were completely relieved from HF. LAD and New York Heart Association (NYHA) were associated with recurrence in the HFpEF and HFmrEF groups, and the maintenance of SR was an independent predictor of NYHA improvement for all HF groups. CONCLUSIONS Patients with HFmrEF and HFpEF could benefit from CBA with high SR maintenance and significant HF improvement.
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Affiliation(s)
- Chaofeng Chen
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Kuan Cheng
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiaofei Gao
- Department of CardiologyAffiliated Hangzhou First People's Hospital, Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Tian Zou
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yang Pang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yunlong Ling
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Ye Xu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yizhou Xu
- Department of CardiologyAffiliated Hangzhou First People's Hospital, Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Qingxing Chen
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Wenqing Zhu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Junbo Ge
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
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Siddiqui MU, Junarta J, Riley JM, Ahmed A, Pasha AK, Limbrick K, Alvarez RJ, Frisch DR. Catheter ablation in patients with atrial fibrillation and heart failure with preserved ejection fraction: A systematic review and meta‐analysis. J Arrhythm 2022; 38:981-990. [DOI: 10.1002/joa3.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/14/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Muhammad U. Siddiqui
- Jefferson Heart Institute, Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Joey Junarta
- Department of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Joshua M. Riley
- Department of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Adnan Ahmed
- Department of Cardiology Kansas City Heart Rhythm Institute Overland Park Kansas USA
| | - Ahmed K. Pasha
- Department of Cardiology United Health Services Binghamton New York USA
| | - Kolin Limbrick
- Nova Southern University College of Osteopathic Medicine Davie Florida USA
| | - Rene J. Alvarez
- Jefferson Heart Institute, Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Daniel R. Frisch
- Jefferson Heart Institute, Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
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5
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Johner N, Namdar M, C Shah D. Safety, Efficacy and Prognostic Benefit of Atrial Fibrillation Ablation in Heart Failure with Preserved Ejection Fraction. Arrhythm Electrophysiol Rev 2022; 11:e18. [PMID: 36304203 PMCID: PMC9585645 DOI: 10.15420/aer.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022] Open
Abstract
Up to 65% of patients with heart failure with preserved ejection fraction (HFpEF) develop AF during the course of the disease. This occurrence is associated with adverse outcomes, including pump failure death. Because AF and HFpEF are mutually reinforcing risk factors, sinus rhythm restoration may represent a disease-modifying intervention. While catheter ablation exhibits acceptable safety and efficacy profiles, no randomised trials have compared AF ablation with medical management in HFpEF. However, catheter ablation has been reported to result in lower natriuretic peptides, lower filling pressures, greater peak cardiac output and improved functional capacity in HFpEF. There is growing evidence that catheter ablation may reduce HFpEF severity, hospitalisation and mortality compared to medical management. Based on indirect evidence, early catheter ablation and minimally extensive atrial injury should be favoured. Hence, individualised ablation strategies stratified by stepwise substrate inducibility provide a logical basis for catheter-based rhythm control in this heterogenous population. Randomised trials are needed for definitive evidence-based guidelines.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
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6
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Androulakis E, Sohrabi C, Briasoulis A, Bakogiannis C, Saberwal B, Siasos G, Tousoulis D, Ahsan S, Papageorgiou N. Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:288. [PMID: 35053984 PMCID: PMC8779551 DOI: 10.3390/jcm11020288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) has been proposed as a means of improving outcomes among patients with heart failure and reduced ejection fraction (HFrEF) who are otherwise receiving appropriate treatment. Unlike HFrEF, treatment options are more limited in patients with preserved ejection fraction (HFpEF) and the data pertaining to the management of AF in these patients are controversial. The aim of this systematic review and meta-analysis was to investigate the effects of CA on outcomes of patients with AF and HFpEF, such as functional status, post-procedural complications, hospitalization, morbidity and mortality, based on data from observational studies. METHODS We systematically searched the electronic databases MEDLINE, PUBMED, EMBASE and the Cochrane Library for Central Register of Clinical Trials until May 2020. RESULTS Overall, the pooling of our data showed that sinus rhythm was achieved long-term in 58.0% (95% CI 0.44-0.71). Long-term AF recurrence was noticed in 22.3% of patients. Admission for HF occurred in 6.2% (95% CI 0.04-0.09) whilst all-cause mortality was identified in 6.3% (95% CI 0.02-0.13). CONCLUSION This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials.
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Affiliation(s)
- Emmanuel Androulakis
- Cardiovascular Imaging Department, Royal Brompton & Harefield Hospital NHS Foundation Trust, London SW3 6NP, UK
- Cardiology Department, St George’s University of London, London SW17 0RE, UK
| | - Catrin Sohrabi
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (C.S.); (B.S.); (N.P.)
| | | | | | - Bunny Saberwal
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (C.S.); (B.S.); (N.P.)
| | - Gerasimos Siasos
- 3rd Cardiology Department, Sotiria Hospital, Athens University Medical School, 11527 Athens, Greece;
| | - Dimitris Tousoulis
- 1st Cardiology Department, Hippokration Hospital, Athens University Medical School, 11527 Athens, Greece;
| | - Syed Ahsan
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BE, UK; (C.S.); (B.S.); (N.P.)
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
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7
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In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Patients With Heart Failure Exacerbation and Atrial Fibrillation: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:145-153. [PMID: 36262793 PMCID: PMC9383350 DOI: 10.36628/ijhf.2022.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/22/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023]
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8
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Aldaas OM, Lupercio F, Darden D, Mylavarapu PS, Malladi CL, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Meta-analysis of the Usefulness of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2021; 142:66-73. [PMID: 33290688 DOI: 10.1016/j.amjcard.2020.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation improves clinical outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF with a preserved ejection fraction (HFpEF) is less clear. We performed a literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR; where a RR <1.0 favors the HFpEF group) and mean difference (MD; where MD <0 favors the HFpEF group) 95% confidence intervals (CI) were measured for dichotomous and continuous variables, respectively. Six studies with a total of 1,505 patients were included, of which 764 (51%) had HFpEF and 741 (49%) had HFrEF. Patients with HFpEF experienced similar recurrence of AF 1 year after ablation on or off antiarrhythmic drugs compared with those with HFrEF (RR 1.01; 95% CI 0.76, 1.35). Fluoroscopy time was significantly shorter in the HFpEF group (MD -5.42; 95% CI -8.51, -2.34), but there was no significant difference in procedure time (MD 1.74; 95% CI -11.89, 15.37) or periprocedural adverse events between groups (RR 0.84; 95% CI 0.54,1.32). There was no significant difference in hospitalizations between groups (MD 1.18; 95% CI 0.90, 1.55), but HFpEF patients experienced significantly less mortality (MD 0.41; 95% CI 0.18, 0.94). In conclusion, based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as safe and efficacious in maintaining sinus rhythm as in those with HFrEF.
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9
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Ariyaratnam JP, Lau DH, Sanders P, Kalman JM. Atrial Fibrillation and Heart Failure: Epidemiology, Pathophysiology, Prognosis, and Management. Card Electrophysiol Clin 2021; 13:47-62. [PMID: 33516407 DOI: 10.1016/j.ccep.2020.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) have similar risk factors, frequently coexist, and potentiate each other in a vicious cycle. Evidence suggests the presence of AF in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) increases the risk of all-cause mortality and stroke, particularly when AF is incident. Catheter ablation may be an effective strategy in controlling symptoms and improving quality of life in AF-HFrEF. Strong data guiding management of AF-HFpEF are lacking largely due to its challenging diagnosis. Improving outcomes associated with these coexistent conditions requires further careful investigation.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia.
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10
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Aldaas OM, Malladi CL, Mylavarapu PS, Lupercio F, Darden D, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Comparison of Outcomes After Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Versus Reduced Ejection Fraction. Am J Cardiol 2020; 136:62-70. [PMID: 32941815 PMCID: PMC7895309 DOI: 10.1016/j.amjcard.2020.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Omar M Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Chaitanya L Malladi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Praneet S Mylavarapu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Douglas Darden
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Frederick T Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Gregory K Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California.
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11
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Abstract
PURPOSE OF REVIEW To review the shared pathology of atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) and the prognostic, diagnostic, and treatment challenges incurred by the co-occurrence of these increasingly prevalent diseases. RECENT FINDINGS Multiple risk factors and mechanisms have been proposed as potentially linking atrial fibrillation and HFpEF, with systemic inflammation more recently being invoked. Nonvitamin K oral anticoagulants, left atrial appendage occlusion devices, and catheter ablation have emerged as alternative treatment options. Other novel pharmacological agents, such as neprilysin inhibitors, need to be studied further in this patient population. SUMMARY Atrial fibrillation and HFpEF commonly co-occur because of their shared risk factors and pathophysiology and incur increased morbidity and mortality relative to either condition alone. Although the presence of both diseases can often make each diagnosis difficult, it is important to do so early in the disease course as there are now a variety of treatment options aimed at improving symptoms and quality of life, slowing disease progression, and improving prognosis. However, more research needs to be performed on the role of catheter ablation in this population. Novel pharmacologic and procedural treatment options appear promising and may further improve the treatment options available to this growing population.
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12
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Kirstein B, Neudeck S, Gaspar T, Piorkowski J, Wechselberger S, Kronborg MB, Zedda A, Hankel A, El-Armouche A, Tomala J, Schmidt T, Mayer J, Wagner M, Ulbrich S, Pu L, Richter U, Huo Y, Piorkowski C. Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study. Europace 2020; 22:1812-1821. [DOI: 10.1093/europace/euaa179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/04/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation.
Methods and results
In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P < 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P < 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P < 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P < 0.001).
Conclusion
Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.
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Affiliation(s)
- Bettina Kirstein
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Sebastian Neudeck
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Judith Piorkowski
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Simon Wechselberger
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Angela Zedda
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Anastasia Hankel
- Steinbeis Research Institute ‘Rhythm and Heart’, Pfotenhauer Straße 76, 01307 Dresden, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Jakub Tomala
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Thomas Schmidt
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Michael Wagner
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Liying Pu
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Yan Huo
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
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