Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation.

Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p < 0.001). Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p < 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m2, p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p > 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p < 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. In the PFA era, the rate of these procedures is progressively increasing as they are readily available and easy to perform compared to thermal ablation.

Marek J ，Stojadinović P ，Wichterle D ，Peichl P ，Hašková J ，Borišincová E ，Štiavnický P ，Čihák R ，Šramko M ，Kautzner J ... -  《-》

Safety and efficacy of catheter ablation in atrial fibrillation patients with heart failure with preserved ejection fraction.

Catheter ablation (CA) for atrial fibrillation (AF) in heart failure patients with preserved ejection fraction (HFPEF) has shown promising results in reducing mortality and improving heart function. However, previous studies have been limited by a lack of control groups and significant heterogeneity in their methodologies. CA for AF in HFPEF patients may not increase the complications and had similarly the rate of freedom from AF vs. patients without HFPEF, and it may reduce hospitalizations and mortality and improve heart function VS medical treatment. Three groups of AF patients were included in the study: 187 patients with HFPEF for their first CA (AFPHF-CA), 187 patients with HFPEF who were undergoing medical therapy (AFPHF-Med), and 196 patients without HFPEF for their first CA (AF-CA). After a mean (± SD) follow-up of 36 ± 3 months, 50.8% of patients in the AFPHF-CA group and 52.0% in the AF-CA group remained in sinus rhythm (P = 0.94), compared to only 12.5% in the AFPHF-Med group (P < 0.001). Age (OR: 1.09, 95% CI: 1.02-1.08, P = 0.016), duration of AF history (OR: 1.01, 95% CI: 1.00-1.02, P = 0.017), left atrial diameter (OR: 1.52, 95% CI: 1.06-2.19, P = 0.024), and the type of atrial fibrillation (OR: 4.02, 95% CI: 1.28-12.62, P = 0.017) were consistent multivariable predictors for sinus rhythm maintenance in AFPHF. HF hospitalization was significantly lower in the AFPHF-CA group (0.38 (0,2)) than in the AFPHF-Med group (1.28(0,3), P < 0.001) during the follow-up. Stroke occurred in 18 of 187 (9.63%) patients in the AFPHF-CA group, significantly lower than the AFPHF-Med group, with approximately 31 of 187 (16.58%) (P < 0.01), but not statistically different from AF-CA, where approximately 17 of 196 (8.67%) experienced stroke (P = 0.65). Regarding mortality, death occurred in 12.8% of patients in the AFPHF-Med group, higher than 7.5% in the AFPHF-CA group and 6.6% in the AF-CA group (P = 0.49). Significant improvements in heart function were observed in the AFPHF-CA group compared to the AFPHF-Med group, including reductions in left ventricular end-diastolic diameter (P < 0.001), New York Heart Association classification (P < 0.001), left ventricular mass index (P < 0.001), and left atrial volume index (P < 0.001). HF hospitalization was significantly lower in the AFPHF-CA group compared to AFPHF-Med (P < 0.001). CA for AF has showed significant benefits in patients with HFPEF compared to medical treatment alone. These benefits include improvements in heart function, reduced mortality, incidence of stroke, and hospitalizations. Importantly, CA in HFPEF patients showed comparable maintenance of sinus rhythm (SR) and safety outcomes when compared to CA in individuals with normal heart function.

Long S ，Sun Y ，Dai S ，Xiao X ，Wang Z ，Sun W ，Gao L ，Xia Y ，Yin X ... -  《-》

Efficacy and limitation of nonparoxysmal atrial fibrillation ablation in patients with heart failure with preserved ejection fraction.

Catheter ablation for atrial fibrillation (AF) reduces heart failure (HF) hospitalization in patients with HF with preserved ejection fraction (HFpEF). However, the long-term outcomes and subclinical HF after nonparoxysmal AF ablation in HFpEF patients have not been fully evaluated. One-hundred-ninety nonparoxysmal AF patients with left ventricular ejection fraction ≥50% who underwent first-time AF ablation were studied. HFpEF was diagnosed from a history of congestive HF and/or combined criteria of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and transthoracic echocardiogram parameters, including average septal-lateral E/e' and tricuspid regurgitation peak velocity. Ninety-five patients with HFpEF (HFpEF group) were compared with 95 patients without HF (CNT group). Low voltage area (LVA) was defined as an area with a bipolar electrogram of <0.5 mV covering >5% of the total left atrial surface. The primary endpoint was a composite of death from any cause or hospitalization for worsening HF. The secondary endpoint was subclinical HFpEF defined from NT-proBNP concentration and average septal-lateral E/e' or tricuspid regurgitation peak velocity at 6-12 months after the procedure irrespective of the rhythm. Kaplan-Meier curves showed that the primary composite endpoint did not differ between the two groups (mean follow-up period 707 ± 75 days, log-rank p = 0.5330). However, significantly more patients in the HFpEF group reached the secondary endpoint (42 [44%] vs. 13 [14%], p < 0.0001). Multivariate analysis revealed that a high preablation NT-proBNP (odds ratio [OR] 1.001, 95% confidence interval [CI] 1.001-1.002, p = 0.0040) and the existence of LVA (OR 5.983, 95% CI 1.463-31.768, p = 0.0194) independently predicted the secondary endpoint in HFpEF patients. After nonparoxysmal AF ablation, mortality of HFpEF patients was not inferior compared to patients without coexisting HF. However, subclinical HF occasionally persisted especially in HFpEF patients with a high preprocedure NT-proBNP concentration and LVA.

Fukui A ，Hirota K ，Mitarai K ，Kondo H ，Yamaguchi T ，Shinohara T ，Takahashi N ... -  《-》

Is sinus rhythm maintenance after repeat catheter ablation effective in patients with atrial fibrillation and heart failure with preserved ejection fraction?

Heart failure (HF) with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are associated with high morbidity and mortality. Recently, sinus rhythm (SR) maintenance (SRM) after catheter ablation (CA) of AF (AFCA) in HFpEF has shown to reduce adverse events as compared to medical treatment. However, it remains unclear whether SRM after a repeat CA for recurrent AF has the same effect as SRM after the initial CA in patients with AF and HFpEF. We studied 244 AF patients with HFpEF who maintained SR after repeat AFCA (repeat CA-SRM group, n = 54) and initial AFCA (initial CA-SRM group, n = 190). HFpEF were defined as HFA-PEFF score of 5 or 6 and left ventricular ejection fraction ≥ 50% before the initial CA. The primary endpoint was a composite of all-cause mortality, HF hospitalizations, or strokes within 3 years after the initial or repeat CA. The incidence of the primary endpoint was similar between the repeat CA-SRM and initial CA-SRM groups (3 of 54 [5.6%] vs. 8 of 190 [4.2%], p = .423 by a log-rank test). There was no significant difference in the 12-month HFA-PEFF score and the proportion of a 12-month HFA-PEFF score <5 between the repeat CA-SRM and the initial CA-SRM groups (5 [4,6] vs. 5 [4,6], p = .915, and 46% vs. 35%, p = .426, respectively). In patients with AF and HFpEF diagnosed by HFA-PEFF score, the primary endpoint of all-cause mortality, HF hospitalizations, and strokes was similar between the repeat CA-SRM and initial CA-SRM groups.

Egami Y ，Kobayashi N ，Sugino A ，Abe M ，Osuga M ，Nohara H ，Kawanami S ，Ukita K ，Kawamura A ，Yasumoto K ，Okamoto N ，Matsunaga-Lee Y ，Yano M ，Nishino M ... -  《-》

Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.

Füting A ，Neven K ，Bordignon S ，Reichlin T ，Blaauw Y ，Hansen J ，Adelino R ，Ouss A ，Roten L ，Mulder BA ，Ruwald MH ，Mené R ，van der Voort P ，Reinsch N ，Kueffer T ，Boveda S ，Albrecht EM ，Raybuck JD ，Sutton B ，Chun KRJ ，Schmidt B ... -  《-》