Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction.

Autor:	Black-Maier E; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Ren X; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina., Steinberg BA; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Green CL; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Barnett AS; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Rosa NS; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Al-Khatib SM; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Atwater BD; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Daubert JP; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Frazier-Mills C; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Grant AO; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Hegland DD; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Jackson KP; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Jackson LR; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Koontz JI; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Lewis RK; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Sun AY; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina., Thomas KL; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Bahnson TD; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Piccini JP; Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: jonathan.piccini@duke.edu.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2018 May; Vol. 15 (5), pp. 651-657. Date of Electronic Publication: 2017 Dec 06.
DOI:	10.1016/j.hrthm.2017.12.001
Abstrakt:	Background: Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Objective: The purpose of this study was to compare outcomes of AF ablation in patients with HFpEF vs HF with reduced ejection fraction (HFrEF). Methods: We performed a retrospective study of 230 patients with HF who underwent AF ablation, including 97 (42.2%) with HFrEF and 133 (57.8%) with HFpEF. Outcomes included adverse events, symptoms (Mayo AF Symptom Inventory [MAFSI]), New York Heart Association (NYHA) functional class, and freedom from recurrent atrial arrhythmia at 12 months. Results: Overall, 150 of 230 patients had nonparoxysmal AF (62.8% HFpEF vs 63.0% HFrEF). Patients with HFpEF had a smaller mean left atrial diameter (4.4 ± 0.8 cm vs 4.7 ± 0.7 cm; P = .013) and were less likely to be taking a beta-blocker at baseline (72.9% vs 85.6%; P = .022). Median (Q1, Q3) procedure times (233 minutes [192, 290] vs 233.5 minutes [193.0, 297.5]; P = .780) and adverse events such as acute HF (3.8% vs 6.2%; P = .395) were similar between HFpEF and HFrEF patients. Freedom from recurrent atrial arrhythmia was not significantly different in HFpEF vs HFrEF patients (33.9% vs 32.6%; adjusted hazard ratio 1.47; 95% confidence interval 0.72-3.01), with similar improvements in NYHA functional class (-0.32 vs -0.19; P = .135) and MAFSI symptom severity (-0.23 vs -0.09; P = .116) after ablation. Conclusion: Catheter ablation of AF seems to have similar effectiveness in patients with HF, regardless of presence of systolic dysfunction. There were no significant differences in procedural characteristics, arrhythmia-free recurrence, or functional improvements between patients with HFpEF and those with HFrEF. (Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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