Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 11:11:1463815.
doi: 10.3389/fcvm.2024.1463815. eCollection 2024.

Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction

Maura M Zylla  1   2   3 , Johannes Leiner  1   2   3 , Ann-Kathrin Rahm  1   2   3 , Tobias Hoffmann  1   2   3 , Patrick Lugenbiel  1   2   3 , Patrick Schweizer  1   2   3 , Christine Mages  1   2   3 , Derliz Mereles  1   2   3 , Meinhard Kieser  4 , Eberhard Scholz  1   2   3 , Hugo A Katus  1   2   3 , Norbert Frey  1   2   3 , Dierk Thomas  1   2   3
Affiliations

Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction

Maura M Zylla et al. Front Cardiovasc Med. .

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) often coincide. Female sex is associated with both increased prevalence of HFpEF and reduced therapeutic efficacy of catheter ablation of AF. This sub-analysis of the previously published AFFECT-study evaluates outcome after cryoballoon-ablation in women with and without HFpEF.

Methods: One-hundred-and-two patients (LVEF ≥ 50%) scheduled for cryoballoon-ablation of AF were prospectively enrolled. Forty-two were female. Comprehensive baseline assessment included echocardiography, stress echocardiography, six-minute-walk-test, biomarker- and quality-of-life-assessment (QoL, SF-36), and was repeated at follow-up ≥12 months after AF-ablation. Baseline parameters, procedural characteristics and outcome after AF-ablation were compared between women with and without HFpEF.

Results: Women with HFpEF (n = 20) were characterized by higher median left atrial volume index (35.8 ml/m2 vs. 25.8 ml/m2, P < 0.001), left ventricular hypertrophy (median left ventricular mass index: 92.0 g/m2 vs. 83.0 g/m2, P = 0.027), reduced distance in the 6-min-walk-test (median: 453 m vs. 527 m, P = 0.008) and higher left atrial pressures (median: 14.0 mmHg vs.9.5 mmHg, P = 0.008) compared to women without HFpEF (n = 21). During follow-up, HFpEF-patients more often experienced AF-related re-hospitalization (36.8% vs. 9.1%, P = 0.039) and numerically higher AF-recurrence-rates (57.9% vs. 31.1%, P = 0.109). There was no significant improvement of heart failure-related symptoms, echocardiographic parameters and cardiac biomarkers levels. QoL showed no significant improvement in both subgroups. Women with HFpEF still exhibited a lower SF-36 Physical Component Summary Score vs. women without HFpEF (median: 41.2 vs. 52.1, P < 0.001).

Conclusion: Women with HFpEF constitute a distinct subgroup with high rates of AF-related events after AF-ablation, and persistence of both symptoms and functional hallmarks of HFpEF. Consideration of sex-specific cardiac co-morbidities is crucial for personalization and optimization of AF-therapy.

Clinical trial registration: ClinicalTrials.gov Identifier NCT05603611.

Keywords: HFpEF; atrial fibrillation; catheter ablation; pulmonary vein isolation; women.

PubMed Disclaimer

Conflict of interest statement

MZ reports lecture fees/honoraria, educational grants and travel support by Medtronic, Boston Scientific, Bayer Vital, ZOLL CMS and Pfizer. A-KR reports educational grants and travel support by Medtronic, Biosense Webster and Boston Scientific. PL reports receiving lecture fees/honoraria from Bayer Vital, Boston Scientific, Biosense Webster, Pfizer and Medtronic. NF reports receiving lecture fees/honoraria from AstraZeneca, Bayer Vital, Boehringer Ingelheim Pharma, Daiichi Sankyo, Novartis and Pfizer Pharma, none of which related to the content of this manuscript. DT reports receiving lecture fees/honoraria from AstraZeneca, Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer Pharma, Sanofi-Aventis, St. Jude Medical and ZOLL CMS. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Arrhythmia-related long-term follow-up. (A) Kaplan-Meier curves depicting freedom from AF-recurrence in women with HFpEF and without heart failure. (B) Kaplan-Meier curves depicting freedom from AF-related hospitalization in women with HFpEF and without heart failure. (C) Comparison of arrhythmia-related endpoints. Percentages per subgroup are indicated within or above columns. AAD, antiarrhythmic drug; ER, emergency room.
Figure 2
Figure 2
Heart failure-related long-term follow-up. (A) Distribution of NYHA-states at baseline and long-term follow-up. Left columns: women with HFpEF. Right columns: women without HFpEF. For statistical comparison by McNemar-test subgroups with NYHA II and NYHA III were summarized. (B) Cardiac symptoms at follow-up. Subgroup comparisons were performed between women with and without HFpEF, as well as between baseline and long-term follow-up within subgroups. (C) Change in heart-failure related biomarkers and 6-min-walktest. Left panel: Performance 6-min-walktest at baseline and follow-up in women with and without HFpEF. Right panel: NTproBNP-levels at baseline and follow-up in women with and without HFpEF.
Figure 3
Figure 3
Quality of life assessment (SF-36). (A) Physical component summary scales (PCS) before and after AF-ablation in women with and without HFpEF. (B) Mental component summary scales (MCS) before and after AF-ablation in women with and without HFpEF.
See this image and copyright information in PMC

References

    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. (2021) 42(5):373–498. 10.1093/eurheartj/ehaa612 - DOI - PubMed
    1. Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. EP Europace. (2024) 26(4):euae043. 10.1093/europace/euae043 - DOI - PMC - PubMed
    1. Zylla MM, Brachmann J, Lewalter T, Hoffmann E, Kuck KH, Andresen D, et al. Sex-related outcome of atrial fibrillation ablation: insights from the German ablation registry. Heart Rhythm. (2016) 13(9):1837–44. 10.1016/j.hrthm.2016.06.005 - DOI - PubMed
    1. Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, et al. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace. (2018) 20(10):1565. 10.1093/europace/euy067 - DOI - PubMed
    1. Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, et al. Impact of female sex on clinical outcomes in the FIRE AND ICE trial of catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol. (2018) 11(5):e006204. 10.1161/CIRCEP.118.006204 - DOI - PubMed

Associated data

LinkOut - more resources