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. 2024 Sep 24;13(19):5685.
doi: 10.3390/jcm13195685.

Heart Failure with Preserved Ejection Fraction Correlates with Fibrotic Atrial Myopathy in Patients Undergoing Atrial Fibrillation Ablation

Jonghui Lee  1 , Michael Sponder  1 , Stefan Stojkovic  1 , Martin Riesenhuber  1 , Andreas Hammer  1 , Thomas M Hofbauer  1 , Patrick Sulzgruber  1 , Stefanie Burger  1 , Stefan Kastl  1 , Franz Duca  1 , Robert Schönbauer  1
Affiliations

Heart Failure with Preserved Ejection Fraction Correlates with Fibrotic Atrial Myopathy in Patients Undergoing Atrial Fibrillation Ablation

Jonghui Lee et al. J Clin Med. .

Abstract

Background: The incidence of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) is high. Impaired left atrial (LA) function is a major determinant in HFpEF. However, the extent of electrical LA tissue degeneration in HFpEF is unknown. Therefore, we sought to investigate the amount of arrhythmogenic and fibrotic LA tissue degeneration in HFpEF patients presenting for AF ablation. Methods: We prospectively screened consecutive patients presenting for first time AF ablation. The HFA-PEFF score was used to identify HFpEF patients. Bipolar high-density voltage mapping was created in sinus rhythm prior to ablation to evaluate the general LA bipolar voltage and quantify areas of low voltage. LVAs were defined as areas with bipolar voltage < 0.5 mV. Results: In total, 187 patients were prospectively enrolled (age 65 ± 11 years, 45% female, 46% persistent AF, 25% HFpEF) in this study. HFpEF patients were older and had a higher CHA2DS2-VASc score (70 ± 9 vs. 63 ± 11 years and 3.2 ± 1.5 vs. 2.3 ± 1.5, each p < 0.001, respectively). Overall, low-voltage areas (LVAs) were present in 97 patients (52%), whereas 76% of the HFpEF population had LVA, as compared to 44% of patients without HFpEF (p < 0.001). HFpEF was associated with generally decreased LA bipolar voltage (1.09 ± 0.64 vs. 1.83 ± 0.91 mV; p < 0.001) and predictive of the presence of low-voltage areas (76% vs. 44% p < 0.001). The HFA-PEFF score inversely correlated with LA bipolar voltage (=-0.454; p < 0.001). Conclusions: HFpEF closely relates to generally decreased LA bipolar voltage and to the existence of fibrotic and arrhythmogenic LA tissue degeneration.

Keywords: HFpEF; atrial fibrillation; atrial myopathy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Boxplots displaying the average left atrial bipolar voltage amplitude, excluding areas of <0.5 mV, according to the presence/absence of HFpEF.
Figure 2
Figure 2
Boxplots displaying the left atrial surface area, according to ascending values of the HFA-PEFF score.
Figure 3
Figure 3
Boxplots displaying the average left atrial bipolar voltage amplitude, according to ascending values of the HFA-PEFF score.
Figure 4
Figure 4
Direct comparison of a high-density left atrial voltage map of a patient without (HFA-PEFF score 0) vs. definite HFpEF (HFA-PEFF score 6). Low-voltage areas are defined as <0.5 mV. Patients with HFpEF have a significantly higher likelihood for the presence of low-voltage areas. Besides the presence of low-voltage areas, HFpEF patients show a generally decreased LA bipolar voltage and larger left atrial surface area. HFpEF, heart failure with preserved ejection fraction; AP, anterior–posterior; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PA, posterior–anterior; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.
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