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Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction. | LitMetric

AI Article Synopsis

  • The study examines the outcomes of cryoballoon-ablation for atrial fibrillation in women, focusing on those with heart failure with preserved ejection fraction (HFpEF) compared to those without.
  • Women with HFpEF displayed worse health indicators, including higher left atrial volume, increased left ventricular mass, reduced walking distances, and higher left atrial pressures.
  • Results showed that women with HFpEF had more frequent hospitalizations due to AF and did not experience significant improvements in heart failure symptoms or quality of life after the procedure, suggesting they represent a high-risk group.

Article Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) often coincide. Female sex is associated with both increased prevalence of HFpEF and reduced therapeutic efficacy of catheter ablation of AF. This sub-analysis of the previously published AFFECT-study evaluates outcome after cryoballoon-ablation in women with and without HFpEF.

Methods: One-hundred-and-two patients (LVEF ≥ 50%) scheduled for cryoballoon-ablation of AF were prospectively enrolled. Forty-two were female. Comprehensive baseline assessment included echocardiography, stress echocardiography, six-minute-walk-test, biomarker- and quality-of-life-assessment (QoL, SF-36), and was repeated at follow-up ≥12 months after AF-ablation. Baseline parameters, procedural characteristics and outcome after AF-ablation were compared between women with and without HFpEF.

Results: Women with HFpEF ( = 20) were characterized by higher median left atrial volume index (35.8 ml/m vs. 25.8 ml/m,  < 0.001), left ventricular hypertrophy (median left ventricular mass index: 92.0 g/m vs. 83.0 g/m,  = 0.027), reduced distance in the 6-min-walk-test (median: 453 m vs. 527 m,  = 0.008) and higher left atrial pressures (median: 14.0 mmHg vs.9.5 mmHg,  = 0.008) compared to women without HFpEF ( = 21). During follow-up, HFpEF-patients more often experienced AF-related re-hospitalization (36.8% vs. 9.1%,  = 0.039) and numerically higher AF-recurrence-rates (57.9% vs. 31.1%,  = 0.109). There was no significant improvement of heart failure-related symptoms, echocardiographic parameters and cardiac biomarkers levels. QoL showed no significant improvement in both subgroups. Women with HFpEF still exhibited a lower SF-36 Physical Component Summary Score vs. women without HFpEF (median: 41.2 vs. 52.1,  < 0.001).

Conclusion: Women with HFpEF constitute a distinct subgroup with high rates of AF-related events after AF-ablation, and persistence of both symptoms and functional hallmarks of HFpEF. Consideration of sex-specific cardiac co-morbidities is crucial for personalization and optimization of AF-therapy.

Clinical Trial Registration: ClinicalTrials.gov Identifier NCT05603611.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586357PMC
http://dx.doi.org/10.3389/fcvm.2024.1463815DOI Listing

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