Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction A Randomized Controlled Trial

被引：71

作者：

Chieng, David ^{[1
,2
,3
]}

Sugumar, Hariharan ^{[1
,2
,3
]}

Segan, Louise ^{[1
,2
,3
]}

Tan, Caleb ^{[1
]}

Vizi, Donna ^{[1
,2
]}

Nanayakkara, Shane ^{[1
,2
]}

Al-Kaisey, Ahmed ^{[1
,3
,4
]}

Hawson, Joshua ^{[3
,4
]}

Prabhu, Sandeep ^{[1
,2
,3
]}

Voskoboinik, Aleksandr ^{[1
,2
,3
]}

Finch, Sue ^{[3
]}

Morton, Joseph B. ^{[3
,4
]}

Lee, Geoffrey ^{[3
,4
]}

Mariani, Justin ^{[2
]}

La Gerche, Andre ^{[2
,3
]}

Taylor, Andrew J. ^{[1
,2
,3
]}

Howden, Erin ^{[1
]}

Kistler, Peter M. ^{[1
,2
,3
,5
]}

Kalman, Jonathan M. ^{[3
,4
,5
]}

Kaye, David M. ^{[1
,2
,5
,6
]}

Ling, Liang-Han ^{[1
,2
,3
,6
]}

机构：

[1] Alfred Hosp, Dept Cardiol, Melbourne, Australia

[2] Baker Heart & Diabet Res Inst, Melbourne, Australia

[3] Univ Melbourne, Melbourne, Australia

[4] Royal Melbourne Hosp, Melbourne, Australia

[5] Monash Univ, Melbourne, Australia

[6] Alfred Hosp, Dept Cardiol, 55 Commercial Rd, Melbourne 3004, Australia

来源：

JACC-HEART FAILURE | 2023年 / 11卷 / 06期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

ablation; atrial fibrillation; brain natriuretic peptide; heart failure with preserved ejection fraction; N-termin al pro- B-type natriuretic peptide; peak pulmonary capillary wedge pressure; VO2; EXERCISE HEMODYNAMICS; CAPACITY;

D O I：

10.1016/j.jchf.2023.01.008

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) frequently develop atrial fibrillation (AF). There are no randomized trials examining the effects of AF ablation on HFpEF outcomes.OBJECTIVES The aim of this study is to compare the effects of AF ablation vs usual medical therapy on markers of HFpEF severity, including exercise hemodynamics, natriuretic peptide levels, and patient symptoms.METHODS Patients with concomitant AF and HFpEF underwent exercise right heart catheterization and cardiopulmonary exercise testing. HFpEF was confirmed with pulmonary capillary wedge pressure (PCWP) of 15 mm Hg at rest or $25 mm Hg on exercise. Patients were randomized to AF ablation vs medical therapy, with investigations repeated at 6 months. The primary outcome was change in peak exercise PCWP on follow-up.RESULTS A total of 31 patients (mean age: 66.1 years; 51.6% females, 80.6% persistent AF) were randomized to AF ablation (n =16) vs medical therapy (n =15). Baseline characteristics were comparable across both groups. At 6 months, ablation reduced the primary outcome of peak PCWP from baseline (30.4 & PLUSMN; 4.2 to 25.4 & PLUSMN; 4.5 mm Hg; P < 0.01). Improvements were also seen in peak relative VO2 (20.2 & PLUSMN; 5.9 to 23.1 & PLUSMN; 7.2 mL/kg/min; P < 0.01), N-terminal pro-B-type natriuretic peptide levels (794 & PLUSMN; 698 to 141 & PLUSMN; 60 ng/L; P = 0.04), and MLHF (Minnesota Living with Heart Failure) score (51 & PLUSMN; -21.9 to 16.6 & PLUSMN; 17.5; P < 0.01). No differences were detected in the medical arm. Following ablation, 50% no longer met exercise right heart catheterization-based criteria for HFpEF vs 7% in the medical arm (P = 0.02).CONCLUSIONS AF ablation improves invasive exercise hemodynamic parameters, exercise capacity, and quality of life in patients with concomitant AF and HFpEF. (J Am Coll Cardiol HF 2023;11:646-658) & COPY; 2023 by the American College of Cardiology Foundation.

引用

页码：646 / 658

页数：13

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