Cryoballoon Ablation in Atrial Fibrillation Plus HFpEF

In a clinical trial published in Circulation: Heart Failure, researchers investigated outcomes of cryoballoon ablation in patients with atrial fibrillation and concurrent heart failure with preserved ejection fraction (HFpEF). According to the study’s lead author, Maura Zylla, MD, this population had a distinct increased risk for atrial fibrillation recurrence after ablation compared with patients without HFpEF.

The study included 102 prospective patients with left ventricular ejection fraction ≥50% undergoing cryoballoon ablation. Of those patients, 24 also had HFpEF. Researchers evaluated participants via echocardiography, stress echocardiography, a 6-minute walk test, biomarkers, and a quality-of-life questionnaire. The trial’s primary end point was differences in procedure parameters and clinical outcomes between patients with or without HFpEF.

Atrial Fibrillation With HFpEF Subgroup Has Worse Ablation Outcomes Versus General Population

Compared with patients without HFpEF, patients with HFpEF were older (median years of age, 74 vs 65; P=.001), more often female (83% vs 28%; P<.001), had more prominent atrial fibrillation-related symptoms (median European Heart Rhythm Association score, 3 vs 2; P<.001), higher left atrial pressures (median mm Hg, 14 vs 10; P=.008), reduced left atrial-appendage velocity (median cm/s, 36 vs 59; P<.001), and reduced 6-minute walk test distance (median distance in meters, 488 vs 539; P<.001).

Patients with HFpEF also had more frequent atrial fibrillation recurrence (57% vs 23%; P=.003), repeat ablation procedure (39% vs 14%), and atrial fibrillation-related rehospitalization (26% vs 7%; P=.016). The researchers also noted that heightened cardiac biomarkers and symptoms of heart failure persisted during follow-up, even in patients with successful rhythm control.

Overall, Zylla and colleagues concluded that patients with atrial fibrillation with HFpEF constitute a distinct subgroup with higher recurrence risk and persistent heart failure symptoms after cryoballoon ablation versus those without HFpEF. They suggested that “future research is needed to optimize treatment strategies in patients with HFpEF.”

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