Improvement of left ventricular function after successful radiofrequency catheter ablation in persistent atrial fibrillation with preserved left ventricular ejection fraction: a comprehensive echocardiographic assessment using two-dimensional speckle tracking analysis

Nagai, Tomoo; Arakawa, Junko; Hamabe, Akira; Tabata, Hidenori

doi:10.1007/s12574-018-0399-z

Cited by 10 publications

(4 citation statements)

References 45 publications

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“…In addition, prior echocardiographic studies have demonstrated reversal of resting left ventricular diastolic dysfunction following successful AF ablation in patients with preserved LVEF 32,33 . This is supported by CMR studies that identified left ventricular fibrotic remodelling with reduction in diffuse fibrosis following ablation in the presence of preserved left ventricular function 34 .…”

Section: Discussionmentioning

confidence: 77%

A prospective STudy using invAsive haemodynamic measurements foLLowing catheter ablation for AF and early HFpEF: STALL AF‐HFpEF

Sugumar

Nanayakkara

Vizi

et al. 2021

European J of Heart Fail

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Aims The impact of atrial fibrillation (AF) ablation in early heart failure with preserved ejection fraction (HFpEF) is unknown. Our aim was to determine the impact of AF ablation on symptoms and exercise haemodynamic parameters of early HFpEF. Methods and results Symptomatic AF patients referred for index AF ablation with ejection fraction ≥50% underwent baseline quality of life questionnaires, echocardiography, cardiac magnetic resonance imaging, exercise right heart catheterisation (exRHC), and brain natriuretic peptide (BNP) testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15 mmHg or peak exercise PCWP ≥25 mmHg. Patients with HFpEF were offered AF ablation and follow‐up exRHC ≥6 months post‐ablation. Of 54 patients undergoing baseline evaluation, 35 (65%) had HFpEF identified by exRHC. HFpEF patients were older (64 ± 10 vs. 54 ± 13 years, P < 0.01), and more frequently female (54% vs. 16%, P < 0.01), hypertensive (63% vs. 16%, P < 0.001), and suffering persistent AF (66% vs. 11%, P < 0.001), compared to those without HFpEF. Twenty HFpEF patients underwent AF ablation and follow‐up exRHC 12 ± 6 months post‐ablation. Nine (45%) patients no longer fulfilled exRHC criteria for HFpEF at follow‐up. Patients remaining arrhythmia free (n = 9, 45%) showed significant improvements in peak exercise PCWP (29 ± 4 to 23 ± 2 mmHg, P < 0.01) and Minnesota Living with Heart Failure (MLHF) score (55 ± 30 to 22 ± 30, P < 0.01) while the remainder did not (PCWP 31 ± 5 to 30.0 ± 4 mmHg, P = NS; MLHF score 55 ± 23 to 25 ± 20, P = NS). Conclusion Heart failure with preserved ejection fraction frequently coexists in patients with symptomatic AF and preserved ejection fraction. Restoration and maintenance of sinus rhythm in patients with comorbid AF and HFpEF improves haemodynamic parameters, BNP and symptoms associated with HFpEF.

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Section: Discussionmentioning

confidence: 77%

A prospective STudy using invAsive haemodynamic measurements foLLowing catheter ablation for AF and early HFpEF: STALL AF‐HFpEF

Sugumar

Nanayakkara

Vizi

et al. 2021

European J of Heart Fail

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“… 5 Moreover, studies have reported the reversal of structural remodelling of the left atrium and left ventricle three months or more after successful ablation in AF patients with preserved LVEF. 16 , 52 , 53 These structural changes can contribute to significant improvements in both systolic and diastolic indices of the left ventricle in patients who maintain SR after AF ablation, ultimately leading to the recovery of HFpEF. 19 , 20 , 53–55 As evidenced by the STALL HFpEF and AF trial, HFpEF patients who maintain SR after AF ablation show significant improvements in peak exercise pulmonary capillary wedge pressure, and almost 45% of patients no longer meet criteria for HFpEF 12 months post-ablation.…”

Section: Discussionmentioning

confidence: 99%

Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction

Xie,

Qi,

Wang

et al. 2023

Europace

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Aims Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have worse clinical outcomes than those with sinus rhythm (SR). We aim to investigate whether maintaining SR in patients with HFpEF through a strategy such as AF ablation would improve outcomes. Methods and results This is a cohort study that analysed 1034 patients (median age 69 [63–76] years, 46.2% [478/1034] female) with HFpEF and AF. Of these, 392 patients who underwent first-time AF ablation were assigned to the ablation group, and the remaining 642 patients, who received only medical therapy, were assigned to the no ablation group. The primary endpoint was a composite of all-cause death or rehospitalization for worsening heart failure. After a median follow-up of 39 months, the cumulative incidence of the primary endpoint was significantly lower in the ablation group compared to the no ablation group (adjusted hazard ratio [HR], 0.55 [95% CI, 0.37–0.82], P = 0.003) in the propensity score-matched model. Secondary endpoint analysis showed that the benefit of AF ablation was mainly driven by a reduction in rehospitalization for worsening heart failure (adjusted HR, 0.52 [95% CI, 0.34–0.80], P = 0.003). Patients in the ablation group showed a 33% relative decrease in atrial tachycardia/AF recurrence compared to the no ablation group (adjusted HR, 0.67 [95% CI, 0.54–0.84], P < 0.001). Conclusion Among patients with HFpEF and AF, the strategy of AF ablation to maintain SR was associated with a lower risk of the composite outcome of all-cause death or rehospitalization for worsening heart failure.

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“…A previous study reported that LAAO after AF ablation was a safe and feasible intervention for stroke prevention [17]. Successful AF ablation could induce LA and LAA reverse remodeling [18,19]. Thus, it would be necessary to repeat LAA measurement when considering the indication for LAAO after AF ablation.…”

Section: Comparison Of Patient Characteristics and Racial Differences Of Laa Morphologymentioning

confidence: 99%

“…Hypertension, stroke, and older age are factors in both the HAS-BLED score and CHA 2 DS 2 -VASc score, and thus many patients with high bleeding risk are also likely to have high thromboembolic risk. Previous studies suggested that major bleeding events during anticoagulant therapy were associated with older age (≥ 75 years), low weight (≤ 50 kg), use of antiplatelet drugs, and uncontrolled hypertension [19][20][21][22][23]. Moreover, most AF patients with a high CHADS 2 score must continue lifelong anticoagulation therapy even after successful ablation [13,24].…”

Section: Bleeding Risk Assessment For Laao Indicationmentioning

confidence: 99%

The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population

et al. 2021

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Background Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with thromboembolic and bleeding risk. We sought to determine the prevalence and characteristics of patients with AF ablation who are potential candidates for WATCHMAN implantation in a Japanese population. Methods We enrolled 2443 consecutive patients who had previously undergone AF ablation and transesophageal echocardiography (TEE). We assessed their clinical characteristics and measured their LAA orifice diameter and depth retrospectively using the obtained TEE images. We defined patients who met both anatomical criteria (LAA orifice max diameter: 17-31 mm and LAA max depth > LAA orifice max diameter) and clinical criteria (CHA 2 DS 2 -VASc score ≥ 2 and HAS-BLED score ≥ 3) as LAAO candidates. Results Among the 2443 enrolled patients, 361 (15%) met the clinical criteria, and 1928 (79%) met the anatomical criteria. Thus 12% (293/2443) of the total patient group met the criteria of LAAO candidates. LAAO candidates showed larger left atrial (LA) volume (77.6 ± 30.1 vs. 67.7 ± 29.1 mL, P < 0.001), larger LAA orifice diameter (22.5 ± 3.2 vs. 22.0 ± 4.3 mm, P = 0.026), and larger LAA depth (28.9 ± 4.6 vs. 27.0 ± 4.8 mm, P < 0.001). LAAO candidates made up only 23% of patients with CHA 2 DS 2 -VASc score ≥ 2 (N = 1295), whereas 78% of patients with a HAS-BLED score ≥ 3 (N = 378) were LAAO candidates. Conclusion Twelve percent of patients who underwent AF ablation were potential candidates for LAAO using a WATCH-MAN device in this Japanese population. It is imperative to evaluate bleeding risk when considering the indications for LAAO.

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Improvement of left ventricular function after successful radiofrequency catheter ablation in persistent atrial fibrillation with preserved left ventricular ejection fraction: a comprehensive echocardiographic assessment using two-dimensional speckle tracking analysis

Cited by 10 publications

References 45 publications

A prospective STudy using invAsive haemodynamic measurements foLLowing catheter ablation for AF and early HFpEF: STALL AF‐HFpEF

A prospective STudy using invAsive haemodynamic measurements foLLowing catheter ablation for AF and early HFpEF: STALL AF‐HFpEF

Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction

The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population

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