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Improvement in symptomatic outcome at one year after catheter ablation for atrial fibrillation is accentuated in patients with heart failure

https://doi.org/10.1007/s00392-024-02526-y

Jan Rieß (Hamburg)1, N. Pohlmann (Hamburg)1, J. Obergassel (Hamburg)1, M. Nies (Hamburg)1, L. Rottner (Hamburg)1, M. Lemoine (Hamburg)2, I. My (Hamburg)2, F. Moser (Hamburg)1, D. Ismaili (Hamburg)1, C. Magnussen (Hamburg)1, B. Reißmann (Hamburg)3, F. Ouyang (Hamburg)1, A. Metzner (Hamburg)2, P. Kirchhof (Hamburg)1, A. Rillig (Hamburg)2

1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland

 

Introduction
Catheter ablation improves quality of life (QoL) in patients with atrial fibrillation (AF). However, data on the impact of comorbid heart failure (HF) on this outcome are limited. This analysis aimed to investigate: 1. the prevalence of heart failure in patients with AF referred for ablation, and 2. QoL one year after AF ablation depending on the presence of comorbid HF at baseline.

 

Methods

This analysis utilized data from the TRUST registry, a prospective, observational clinical cohort, that has been enrolling patients with heart rhythm disorders at a large tertiary-care center since March 2021. A subset of TRUST patients undergoing first time or repeat ablation for AF between 08/2021 and 11/2022, was analyzed. Patients were assigned to either HFrEF, HFmrEF, HFpEF or no HF according to 2021 ESC guidelines. Symptomatic outcomes were systematically assessed at baseline and after one year during remote, telephone-based follow-up of the trial via the 'Atrial Fibrillation Effect on QualiTy-of-life' (AFEQT) questionnaire.

 

Results

Complete data for analysis were available for 240/505 of patients (72% first-Do ablation, 39% women, median age 68 [IQR 60; 76] years, median BMI 26.0 [IQR 24; 30] kg/m², median NT-proBNP 664 [IQR 196; 1631] pg/mL, median LVEF 55 [IQR 50; 69]%). 10% patients met the criteria for HFrEF (n=25), 11% for HFmrEF (n=26), and 31% for HFpEF (n=75). 48% had no HF (n=114). AFEQT summary score showed a significant improvement in AF-related QoL one year after catheter ablation (55.6 vs. 66.7 points, p < .001). This improvement was mainly driven by patients with HFpEF (49.1 vs. 58.3, p < .001). Changes in AFEQT summary score in AF patients without HF (68.1 vs. 73.2, p = .119), with HFmrEF (53.5 vs. 59.4, p = .424), and with HFrEF (43.5 vs. 50.0, p > .999) did not reach statistical significance. Baseline QoL differed significantly between subgroups and was lower in patients with HF as compared to patients without (p < .001).

 

Conclusion

The prevalence of HF, particularly HFpEF, in patients referred for AF ablation was high and associated with a lower QoL at baseline compared to AF patients without HF. Catheter ablation led to a significant improvement in AF-related QoL across the entire cohort, foremost in patients with comorbid HFpEF.


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