Comparison of Catheter Ablation in Patients with Paroxysmal Non-valvular Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction

被引：0

作者：

Zhang, Zixi ^{[1
]}

Lin, Qiuzhen ^{[1
]}

Wang, Cancan ^{[2
]}

Wu, Keke ^{[1
]}

Huang, Yunying ^{[1
]}

Tu, Tao ^{[1
]}

Zhang, Zeying ^{[1
]}

Tang, Hanze ^{[1
]}

Xiao, Yichao ^{[1
]}

Liu, Qiming ^{[1
]}

机构：

[1] Cent South Univ, Xiangya Hosp 2, Dept Cardiol, 139 Renmin Rd, Changsha 410011, Hunan, Peoples R China

[2] Cent South Univ, Xiangya Hosp 2, Dept Endocrinol, Changsha 410011, Hunan, Peoples R China

来源：

INTERNATIONAL JOURNAL OF MEDICAL SCIENCES | 2025年 / 22卷 / 02期

基金：

中国国家自然科学基金;

关键词：

Atrial fibrillation (AF); Heart failure with preserved ejection fraction (HFpEF); Radiofrequency ablation (RFA); Cryoballoon ablation (CBA); Pulsed field ablation (PFA);

D O I：

10.7150/ijms.103170

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The efficacy of radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been established, but the efficacy and safety of cryoballoon ablation (CBA) and pulsed field ablation (PFA) remain unclear. Methods: This retrospective cohort study included 223 patients with paroxysmal non-valvular AF and HFpEF who underwent their first AF ablation between January 2017 and December 2021 and were divided into RFA (n = 77), CBA (n = 127), and PFA (n = 19) groups. Results: After a mean follow-up of 11.2 +/- 1.8 months, no significant differences were observed in the rates of AF recurrence among the groups (P = 0.964). Both RFA and PFA were associated with a reduction in left atrial diameter and an increase in left ventricular ejection fraction (LVEF), whereas CBA showed no significant changes. The New York Heart Association (NYHA) functional classification and quality of life scores significantly improved across all groups (P < 0.01). No significant differences in the incidence of postprocedural complications were observed. Multivariate Cox regression analysis identified serum albumin (ALB) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) as independent predictors of AF recurrence post-ablation. Conclusion: RFA, CBA, and PFA are all effective in maintaining sinus rhythm in patients with paroxysmal non-valvular AF and HFpEF. RFA and PFA were associated with improved quality of life, improved NYHA functional classification, reversal of atrial remodeling, and increased LVEF. While CBA improved quality of life and NYHA functional status, it did not reverse atrial remodeling or increase LVEF. ALB and NT-pro BNP levels were identified as independent predictors of AF recurrence post-ablation in HFpEF patients.

引用

页码：371 / 382

页数：12

共 35 条

[1] Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Et al., 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, J Am Coll Cardiol, 149, (2024)
[2] Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA., Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis, BMJ, 354, (2016)
[3] Kotecha D, Lam CSP, Van Veldhuisen DJ, Van Gelder IC, Voors AA, Rienstra M., Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Vicious Twins, J Am Coll Cardiol, 68, pp. 2217-2228, (2016)
[4] Packer DL, Piccini JP, Monahan KH, Al-Khalidi HR, Silverstein AP, Noseworthy PA, Et al., Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial, Circulation, 143, pp. 1377-1390, (2021)
[5] Aldaas OM, Lupercio F, Darden D, Mylavarapu PS, Malladi CL, Han FT, Et al., Meta-analysis of the Usefulness of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction, Am J Cardiol, 142, pp. 66-73, (2021)
[6] Rattka M, Pott A, Kuhberger A, Weinmann K, Scharnbeck D, Stephan T, Et al., Restoration of sinus rhythm by pulmonary vein isolation improves heart failure with preserved ejection fraction in atrial fibrillation patients, Europace, 22, pp. 1328-1336, (2020)
[7] Zylla MM, Leiner J, Rahm A-K, Hoffmann T, Lugenbiel P, Schweizer P, Et al., Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure and Preserved Ejection Fraction, Circ Heart Fail, 15, (2022)
[8] Zhang Z, Xiao Y, Dai Y, Lin Q, Liu Q., Device therapy for patients with atrial fibrillation and heart failure with preserved ejection fraction, Heart Fail Rev, 29, pp. 417-430, (2024)
[9] McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Et al., 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, Eur Heart J, 42, pp. 3599-726, (2021)
[10] Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Et al., 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee, J Am Coll Cardiol, 81, pp. 1835-1878, (2023)

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