Catheter ablation for patients with atrial fibrillation and heart failure: insights from the swedish heart failure registry

Olshausen, Gesa von; Benson, Lina; Dahlström, Ulf; Lund, L. H.; Savarese, Gianluigi; Braunschweig, Frieder

doi:10.1093/europace/euac053.241

Cited by 4 publications

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“…The need to maintain a short time between AF diagnosis and rhythm control strategies is of special value in AF ablation, as highlighted by recent studies and meta‐analyses, 10 and this may be even more important in HFpEF, taking into account the mutual links and the pathophysiological and clinical convergence existing between AF and HFpEF 5 . In this issue of the Journal, von Olshausen et al 11 . report on data from the Swedish Heart Failure Registry (years 2005–2019) targeted to investigate the association between catheter ablation for AF and outcome, in terms of mortality and HF hospitalizations in patients with HF across the entire LVEF spectrum.…”

Section: Figurementioning

confidence: 99%

“…Actually, in the study of von Olshausen et al, 11 the number of ablations performed in AF patients was low, corresponding to 1% of the patients enrolled in Swedish HF Registry. This finding is in agreement with other real-world reports.…”

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confidence: 97%

“…9 The need to maintain a short time between AF diagnosis and rhythm control strategies is of special value in AF ablation, as highlighted by recent studies and meta-analyses, 10 and this may be even more important in HFpEF, taking into account the mutual links and the pathophysiological and clinical convergence existing between AF and HFpEF. 5 In this issue of the Journal, von Olshausen et al 11 Both matching and the analysis considered three pre-specified ejection fraction subgroups, i.e. preserved (HFpEF, LVEF ≥50%), mildly reduced (HFmrEF, LVEF 40-49%) and reduced ejection fraction (HFrEF, LVEF <40%).…”

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confidence: 99%

“…More recently, AF ablation has gained an important role in rhythm control for AF and is absolutely recommended as first choice option over medical therapy when atrial tachycardiomyopathy is suspected. 6 According to literature, AF ablation may achieve favourable results at mid and long term in patients with HF, even if relatively few studies (Table 1) 11,[13][14][15][16][17][18][19][20][21][22] classified patients according to LVEF into HFrEF, HFmrEF and HFpEF. Future challenges in the clinical field are related to the ability to predict clinical response in terms of regression of LV dysfunction and HF, and specifically identify a priori the cases of atrial tachycardiomyopathy who will exhibit complete regression of LV dysfunction.…”

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confidence: 99%

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Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

Boriani

Vitolo

Imberti

2022

European J of Heart Fail

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This article refers to 'Catheter ablation for patients with atrial fibrillation and heart failure: insights from the Swedish Heart Failure Registry' by G. von Olshausen et al., published in this issue on pages 1636-1646.Atrial fibrillation (AF) and heart failure (HF) are two common cardiac diseases, affecting 1-2% of the population with a prevalence that rises steeply with age. 1 They are conditioned and promoted by common risk factors and frequently coexist with complex dynamic interactions 1 (Figure 1). Although left ventricular ejection fraction (LVEF) shows substantial limitations in terms of imprecision, intra-, and inter-observer variability, 2 the classification of patients with HF is currently based on three different categories according to LVEF, i.e. patients with preserved (HFpEF, LVEF ≥50%), mildly reduced (HFmrEF, LVEF 41-49%), and reduced ejection fraction (HFrEF, LVEF ≤40%). 3 HFpEF is estimated to account for approximately half of HF cases, even if its epidemiological profile is of complex assessment in consideration of the lack of standardized criteria for its diagnosis in the past and substantial heterogeneity in clinical presentation, underlying aetiology, precipitating factors, and associated comorbidities. 4 The haemodynamic consequences of AF are related to loss of atrial contribution to cardiac output, to increase in heart rate with shortening in the duration of diastole, and to irregularity in diastolic intervals. Loss of atrial transport is particularly significant if there is impairment in left ventricular (LV) filling, due to reduced diastolic compliance, as in many cases of HFpEF. In this patient subset, a high heart rate or an irregular heart rate with frequent short diastolic intervals may be poorly tolerated as well, resulting in increased capillary wedge pressure. 5 Apart from these considerations, it is well acknowledged that a sustained uncontrolled tachycardia with heart rate >120 bpm may be associated at long term with an impairment of LV function, which may result in important worsening of the clinical conditions, unless heart rate can be controlled or sinusThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Section: Figurementioning

confidence: 99%

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confidence: 97%

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confidence: 99%

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confidence: 99%

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Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction

Boriani

Vitolo

Imberti

2022

European J of Heart Fail

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“…The primary endpoint of all‐cause mortality or first HF hospitalization was lower among patients who underwent AF ablation versus conservative management, irrespective of LVEF. Moreover, catheter ablation was associated with a lower risk of recurrent HF hospitalization in patients with HF and preserved ejection fraction (HFpEF) 41 …”

Section: Devicesmentioning

confidence: 99%