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Randomized Controlled Trial
. 2023 Jun;11(6):646-658.
doi: 10.1016/j.jchf.2023.01.008. Epub 2023 Mar 1.

Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction: A Randomized Controlled Trial

David Chieng  1 , Hariharan Sugumar  1 , Louise Segan  1 , Caleb Tan  2 , Donna Vizi  3 , Shane Nanayakkara  3 , Ahmed Al-Kaisey  4 , Joshua Hawson  5 , Sandeep Prabhu  1 , Aleksandr Voskoboinik  1 , Sue Finch  6 , Joseph B Morton  5 , Geoffrey Lee  5 , Justin Mariani  7 , Andre La Gerche  8 , Andrew J Taylor  1 , Erin Howden  2 , Peter M Kistler  9 , Jonathan M Kalman  10 , David M Kaye  11 , Liang-Han Ling  12
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Free article
Randomized Controlled Trial

Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction: A Randomized Controlled Trial

David Chieng et al. JACC Heart Fail. 2023 Jun.
Free article

Abstract

Background: Patients with heart failure with preserved ejection fraction (HFpEF) frequently develop atrial fibrillation (AF). There are no randomized trials examining the effects of AF ablation on HFpEF outcomes.

Objectives: The aim of this study is to compare the effects of AF ablation vs usual medical therapy on markers of HFpEF severity, including exercise hemodynamics, natriuretic peptide levels, and patient symptoms.

Methods: Patients with concomitant AF and HFpEF underwent exercise right heart catheterization and cardiopulmonary exercise testing. HFpEF was confirmed with pulmonary capillary wedge pressure (PCWP) of 15 mm Hg at rest or ≥25 mm Hg on exercise. Patients were randomized to AF ablation vs medical therapy, with investigations repeated at 6 months. The primary outcome was change in peak exercise PCWP on follow-up.

Results: A total of 31 patients (mean age: 66.1 years; 51.6% females, 80.6% persistent AF) were randomized to AF ablation (n = 16) vs medical therapy (n = 15). Baseline characteristics were comparable across both groups. At 6 months, ablation reduced the primary outcome of peak PCWP from baseline (30.4 ± 4.2 to 25.4 ± 4.5 mm Hg; P < 0.01). Improvements were also seen in peak relative VO2 (20.2 ± 5.9 to 23.1 ± 7.2 mL/kg/min; P < 0.01), N-terminal pro-B-type natriuretic peptide levels (794 ± 698 to 141 ± 60 ng/L; P = 0.04), and MLHF (Minnesota Living with Heart Failure) score (51 ± -21.9 to 16.6 ± 17.5; P < 0.01). No differences were detected in the medical arm. Following ablation, 50% no longer met exercise right heart catheterization-based criteria for HFpEF vs 7% in the medical arm (P = 0.02).

Conclusions: AF ablation improves invasive exercise hemodynamic parameters, exercise capacity, and quality of life in patients with concomitant AF and HFpEF.

Keywords: N-terminal pro–B-type natriuretic peptide; VO(2); ablation; atrial fibrillation; brain natriuretic peptide; heart failure with preserved ejection fraction; peak pulmonary capillary wedge pressure.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Chieng is supported by co-funded NHMRC/NHF post-graduate scholarship. Dr Prabhu has received an NHMRC Post-Doctoral Research Fellowship. Dr Voskoboinik has received a National Heart Foundation Early Career Fellowship. Dr Lee has received consulting fees from Biosense Webster. Dr Kistler has received funding from Abbott Medical for consultancy and speaking engagements; and has served on the advisory board with fellowship support from Biosense Webster. Dr Kalman has received fellowship support from Medtronic and Biosense Webster. Dr Kaye has received an NHMRC Investigator Grant. Dr Ling has received funding from Abbott Medical for project funding, consultancy, and speaking engagements; and has received funding from Abbott Medical for project funding, consultancy, and speaking engagements. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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