Heart Failure score and outcomes in patients with preserved ejection fraction after catheter ablation for atrial fibrillation

Abstract

Aims: Atrial fibrillation (AF) is frequently associated with heart failure with preserved ejection fraction (HFpEF), but the diagnosis and prediction of the outcomes of HFpEF are difficult. Notably, the Heart Failure Association of the European Society of Cardiology proposed the use of the HFA-PEFF score in the diagnosis of HFpEF. This study aimed to assess the prognostic value of the pre- and post-procedural HFA-PEFF scores in patients with preserved ejection fraction (EF) after catheter ablation (CA) for AF. The primary endpoint was a composite of cardiac hospitalization for cardiovascular events and all-cause mortality. The secondary endpoint was AF recurrence.

Methods and results: Overall, 354 patients with AF and preserved EF who underwent CA as well as blood tests and transthoracic echocardiography 2 weeks before and 6 months after CA from January 2018 to December 2019 were retrospectively enrolled in the study. In the 354 participants, univariate analysis showed that the post-procedural HFA-PEFF score was associated with a 3-year risk of the primary endpoint (hazard ratio [HR] = 3.73; 95% confidence interval [CI] = 2.07-6.73; P < 0.001), whereas the pre-procedural HFA-PEFF score was not (HR = 1.24, 95% CI = 0.82-1.86, P = 0.307). Further, the association between the post-procedural HFA-PEFF score and primary endpoint was not modified even after including other relevant variables into the score. Similar to the primary endpoint, the post-procedural HFA-PEFF score was associated with the 3-year risk of AF recurrence (P < 0.001).

Conclusions: In patients with preserved EF undergoing AF ablation, the HFA-PEFF score at 6 months after CA was associated with the primary endpoint and AF recurrence at the 3-year follow-up.

Keywords: Atrial fibrillation; Catheter ablation; HFA–PEFF score; Outcomes; Preserved ejection fraction.

Figure 1

Study flow chart. AF, atrial fibrillation; CA, catheter ablation; EF, ejection fraction; TTE, transthoracic echocardiography.

Figure 2

Kaplan–Meier cumulative rate of primary endpoint events classified by pre‐procedural and post‐procedural HFA–PEFF score. (A) Pre‐procedural HFA–PEFF score. (B) Post‐procedural HFA–PEFF score.

Figure 3

(A) Area under the curve for the prediction of the primary endpoint. (B) Area under the curve for the prediction of AF recurrence. AF, atrial fibrillation.

Figure 4

Kaplan–Meier cumulative rate of AF recurrence classified by pre‐procedural and post‐procedural HFA–PEFF score. (A) Pre‐procedural HFA–PEFF score. (B) Post‐procedural HFA–PEFF score. AF, atrial fibrillation.