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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Frontiers Media S.A.
2024-11-01
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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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institution | Kabale University |
issn | 2297-055X |
language | English |
publishDate | 2024-11-01 |
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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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