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

BackgroundHeart 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 evalu...

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Main Authors: Maura M. Zylla, Johannes Leiner, Ann-Kathrin Rahm, Tobias Hoffmann, Patrick Lugenbiel, Patrick Schweizer, Christine Mages, Derliz Mereles, Meinhard Kieser, Eberhard Scholz, Hugo A. Katus, Norbert Frey, Dierk Thomas
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Language:English
Published: Frontiers Media S.A. 2024-11-01
Series:Frontiers in Cardiovascular Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2024.1463815/full
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author Maura M. Zylla
Maura M. Zylla
Maura M. Zylla
Johannes Leiner
Johannes Leiner
Johannes Leiner
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Tobias Hoffmann
Tobias Hoffmann
Tobias Hoffmann
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Schweizer
Patrick Schweizer
Patrick Schweizer
Christine Mages
Christine Mages
Christine Mages
Derliz Mereles
Derliz Mereles
Derliz Mereles
Meinhard Kieser
Eberhard Scholz
Eberhard Scholz
Eberhard Scholz
Hugo A. Katus
Hugo A. Katus
Hugo A. Katus
Norbert Frey
Norbert Frey
Norbert Frey
Dierk Thomas
Dierk Thomas
Dierk Thomas
author_facet Maura M. Zylla
Maura M. Zylla
Maura M. Zylla
Johannes Leiner
Johannes Leiner
Johannes Leiner
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Tobias Hoffmann
Tobias Hoffmann
Tobias Hoffmann
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Schweizer
Patrick Schweizer
Patrick Schweizer
Christine Mages
Christine Mages
Christine Mages
Derliz Mereles
Derliz Mereles
Derliz Mereles
Meinhard Kieser
Eberhard Scholz
Eberhard Scholz
Eberhard Scholz
Hugo A. Katus
Hugo A. Katus
Hugo A. Katus
Norbert Frey
Norbert Frey
Norbert Frey
Dierk Thomas
Dierk Thomas
Dierk Thomas
author_sort Maura M. Zylla
collection DOAJ
description BackgroundHeart 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.MethodsOne-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.ResultsWomen 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).ConclusionWomen 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 RegistrationClinicalTrials.gov Identifier NCT05603611.
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spelling doaj-art-ae3e1191ad254d2f90c70a980a4b58a52024-11-11T06:10:30ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-11-011110.3389/fcvm.2024.14638151463815Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fractionMaura M. Zylla0Maura M. Zylla1Maura M. Zylla2Johannes Leiner3Johannes Leiner4Johannes Leiner5Ann-Kathrin Rahm6Ann-Kathrin Rahm7Ann-Kathrin Rahm8Tobias Hoffmann9Tobias Hoffmann10Tobias Hoffmann11Patrick Lugenbiel12Patrick Lugenbiel13Patrick Lugenbiel14Patrick Schweizer15Patrick Schweizer16Patrick Schweizer17Christine Mages18Christine Mages19Christine Mages20Derliz Mereles21Derliz Mereles22Derliz Mereles23Meinhard Kieser24Eberhard Scholz25Eberhard Scholz26Eberhard Scholz27Hugo A. Katus28Hugo A. Katus29Hugo A. Katus30Norbert Frey31Norbert Frey32Norbert Frey33Dierk Thomas34Dierk Thomas35Dierk Thomas36Department of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyInstitute of Medical Biometry, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyDepartment of Cardiology, Medical University Hospital, Heidelberg, GermanyHeidelberg Center forHeart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Heidelberg, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, GermanyBackgroundHeart 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.MethodsOne-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.ResultsWomen 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).ConclusionWomen 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 RegistrationClinicalTrials.gov Identifier NCT05603611.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1463815/fullatrial fibrillationcatheter ablationpulmonary vein isolationwomenHFpEF
spellingShingle Maura M. Zylla
Maura M. Zylla
Maura M. Zylla
Johannes Leiner
Johannes Leiner
Johannes Leiner
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Ann-Kathrin Rahm
Tobias Hoffmann
Tobias Hoffmann
Tobias Hoffmann
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Lugenbiel
Patrick Schweizer
Patrick Schweizer
Patrick Schweizer
Christine Mages
Christine Mages
Christine Mages
Derliz Mereles
Derliz Mereles
Derliz Mereles
Meinhard Kieser
Eberhard Scholz
Eberhard Scholz
Eberhard Scholz
Hugo A. Katus
Hugo A. Katus
Hugo A. Katus
Norbert Frey
Norbert Frey
Norbert Frey
Dierk Thomas
Dierk Thomas
Dierk Thomas
Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
Frontiers in Cardiovascular Medicine
atrial fibrillation
catheter ablation
pulmonary vein isolation
women
HFpEF
title Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
title_full Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
title_fullStr Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
title_full_unstemmed Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
title_short Catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
title_sort catheter ablation of atrial fibrillation in women with heart failure with preserved ejection fraction
topic atrial fibrillation
catheter ablation
pulmonary vein isolation
women
HFpEF
url https://www.frontiersin.org/articles/10.3389/fcvm.2024.1463815/full
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