Atrial fibrillation and heart failure temporality: does it matter?

Deutekom, C Van; Gelder, Isabelle C. Van; Rienstra, Michiel

doi:10.1093/europace/euac255

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…The highest survival rate, as reported by Hunter et al [27], reached 92%. In the CASTLE-AF study, the SR maintenance rate was 75% across 37 months of follow-up [25,27]. Within our research, the SR maintenance rate was 57%, and 40 patients (21.9%) underwent repeat procedures.…”

Section: Efficacy Of Ca In Sr Maintenancementioning

confidence: 51%

“…The primary rationale may be the superior rate of SR retention in TIC and the more pronounced enhancement in cardiac function in comparison to both groups. Deutekom [25] considered that exploring the temporality of AF and the different LVEF-based subtypes of HF and its prognostic impact would be needed in the future.…”

Section: Long-term Outcome After Af Ablation In Patients With Reduced...mentioning

confidence: 99%

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Benefit of Catheter Ablation for Atrial Fibrillation in Heart Failure Patients with Different Etiologies

Long,

Sun,

Xiao

et al. 2023

JCDD

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(1) Background: A plethora of studies have elucidated the safety and efficacy of catheter ablation (CA) for patients afflicted with atrial fibrillation (AF) and concomitant reduction in left ventricular ejection fraction (LVEF). Nevertheless, the literature on the benefits of CA in the specific etiological context of heart failure (HF) remains limited. This study delineates a comparative assessment of outcomes for patients with AF and reduced LVEF across the primary etiologies. (2) Methods: Our inquiry encompassed 216 patients diagnosed with congestive heart failure and an LVEF of less than 50 percent who were referred to our institution for circumferential pulmonary vein isolation (CPVI) between the years 2016 and 2020. The selection criteria included a detailed medical history while excluding those suffering from valvular disease, congenital heart disease, and hypertrophic cardiomyopathy. In an effort to scrutinize varying etiologies, patients were stratified into three categories: dilated cardiomyopathy (DCM, n = 56, 30.6%), ischemic cardiomyopathy (ICM, n = 68, 37.2%), and tachycardia-induced cardiomyopathy (TIC, n = 59, 32.2%). (3) Results: Following an average (±SD) duration of 36 ± 3 months, the prevalence of sinus rhythm was 52.1% in the DCM group, 50.0% in the ICM group, and 68.14% in the TIC group (p = 0.014). This study revealed a significant disparity between the DCM and TIC groups (p = 0.021) and the ICM and TIC groups (p = 0.007), yet no significant distinction was discerned between the TIC and ICM groups (p = 0.769). Importantly, there were no significant variations in the application of antiarrhythmic drugs or recurrence of procedures among the three groups. The mortality rates were 14.29% for the DCM group and 14.71% for the ICM group, which were higher than the 3.39% observed in the TIC group (DCM vs. TIC p = 0.035 (HR = 4.50 (95%CI 1.38–14.67)), ICM vs. TIC p = 0.021 (HR = 5.00 (95%CI 1.61–15.50))). A noteworthy enhancement in heart function was evidenced in the TIC group in comparison to the DCM and ICM groups, including a higher LVEF (p < 0.001), diminution of LV end-diastolic diameter (p < 0.001), and an enhanced New York Heart Association classification (p = 0.005). Hospitalization rates for heart failure were discernibly lower in TIC patients (0.98 (0,2) times) relative to those with DCM (1.74 (0,3) times, p < 0.01) and TIC (1.78 (0,4) times, p < 0.001). Patients with paroxysmal atrial fibrillation and brief episodes were found to achieve superior clinical outcomes through a catheter ablation strategy. (4) Conclusion: Patients diagnosed with TIC demonstrated a more pronounced benefit from catheter ablation compared to those with DCM and ICM. This encompassed an augmented improvement in cardiac function, an enhanced maintenance of sinus rhythm, and a reduced mortality rate.

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Section: Efficacy Of Ca In Sr Maintenancementioning

confidence: 51%

Section: Long-term Outcome After Af Ablation In Patients With Reduced...mentioning

confidence: 99%

Benefit of Catheter Ablation for Atrial Fibrillation in Heart Failure Patients with Different Etiologies

Long,

Sun,

Xiao

et al. 2023

JCDD

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“…(91) However, temporality of whether HF or AF comes first has impact in outcomes (92,93). When HF happens first, the incidence of AF seems to be a sign of worse prognosis and more irreversible pathophysiological mechanisms, which ultimately lead to poor prognosis (92)(93)(94)(95). When AF happens first, the development of HF can be a bystander as it may be caused by a tachycardiomyopathy, which could be reversible, albeit not in all patients having a better prognosis (92)(93)(94)(95).…”

mentioning

confidence: 99%

“…When HF happens first, the incidence of AF seems to be a sign of worse prognosis and more irreversible pathophysiological mechanisms, which ultimately lead to poor prognosis (92)(93)(94)(95). When AF happens first, the development of HF can be a bystander as it may be caused by a tachycardiomyopathy, which could be reversible, albeit not in all patients having a better prognosis (92)(93)(94)(95). In the context of HF with the reduced ejection fraction (rEF) phenotype, its diagnosis is straightforward by symptoms, results from echocardiography, and B-type natriuretic peptide (BNP) or N-terminal pro-hormone BNP (NTproBNP).…”

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confidence: 99%

Towards understanding atrial cardiomyopathy in atrial fibrillation

Artola Arita

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Atrial fibrillation (AF) is the most common arrhythmia and is a growing epidemic.(1-6) The prevalence of AF has increased 3-fold in the last 50 years and recent data shows a lifetime risk of 1 in 3 in people with European ancestry and 1 in 5 people with Afro-American ancestry. (2,5) Available data estimates that AF affects on average 9 million people in Europe and 5 million people in the United States older than 55 years and it is expected that these ciphers double or triple by the year 2050.(2,6) The incidence of AF is increasing due to aging of the population, improved diagnostic tools to detect AF, more awareness of its existence and better survival due to advanced therapies for associated comorbidities. (2,5,6) AF is a progressive disease that often starts with sporadic self-terminating episodes and may evolve to more frequent, longer and non-self-terminating AF.( 7) AF progression has been associated with worse prognosis, such as an increase in development of heart failure (HF) hospitalizations,(8,9) stroke,(10) mortality,(10) and impairment of quality of life.( 11) Patients with AF often present with symptoms such as palpitations, fatigue, dizziness, dyspnoea, chest pain and anxiety.(12) However, AF may also be asymptomatic.( 13) AF almost never comes alone and is associated with risk factors and comorbidities, including hypertension, obesity and heart failure(Figure 1).(14,15) Risk factors and comorbidities may start already the remodelling processes of the atria (and ventricles) long before the first AF episode is being detected (Figure 2).(3,9,18) Established traditional risk factors and comorbidities include ageing, coronary heart disease, heart failure, hypertension, diabetes, obesity, significant valvular diseases, thyroid disease, and excessive as well as deficient physical activity (Figure 1).(3,6,15) Progression of AF further contributes to deterioration of the remodelling processes (Figure 2).( 17) AF also affects ventricular remodelling. (17) The presence of these risk factors and comorbidities cause electrical and structural changes in the atria, nowadays named Atrial Cardiomyopathy (ACM), and sets the stage for AF initiation and its progression.

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Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model

Bergonti

Ascione

Marcon

et al. 2023

European Heart Journal

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Aims Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort. Methods and results A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the ‘2021 Universal Definition of HF’ criteria for LVEF recovery and were defined as ‘responders’. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82–0.89], P < .001; Hosmer–Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45–17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05–0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04–0.31, P < .001). Conclusion In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.

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Atrial fibrillation and heart failure temporality: does it matter?

Cited by 6 publications

References 11 publications

Benefit of Catheter Ablation for Atrial Fibrillation in Heart Failure Patients with Different Etiologies

Benefit of Catheter Ablation for Atrial Fibrillation in Heart Failure Patients with Different Etiologies

Towards understanding atrial cardiomyopathy in atrial fibrillation

Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model

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