Author + information
- Received May 8, 2013
- Revision received July 1, 2013
- Accepted July 9, 2013
- Published online November 12, 2013.
- Tomoko Machino-Ohtsuka, MD,
- Yoshihiro Seo, MD∗ (, )
- Tomoko Ishizu, MD,
- Akinori Sugano, MD,
- Akiko Atsumi, MD,
- Masayoshi Yamamoto, MD,
- Ryo Kawamura, MD,
- Takeshi Machino, MD,
- Kenji Kuroki, MD,
- Hiro Yamasaki, MD,
- Miyako Igarashi, MD,
- Yukio Sekiguchi, MD and
- Kazutaka Aonuma, MD
- ↵∗Reprint requests and correspondence:
Dr. Yoshihiro Seo, Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
Objectives This study sought to investigate the efficacy and safety of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFPEF).
Background AF is a precipitating factor for clinical deterioration of HFPEF.
Methods Catheter ablation for AF was performed in a consecutive 74 patients with compensated HFPEF (left ventricular [LV] ejection fraction >50%). AF-free probability after catheter ablation and factors relating to maintenance of sinus rhythm were investigated. LV strain and strain rate were assessed by echocardiography at baseline and over 12 months after ablation.
Results During a 34 ± 16-month follow-up period, single- and multiple-procedure drug-free success rates were 27% (n = 20) and 45% (n = 33), respectively. Multiple procedures and pharmaceutically assisted success rate was 73% (n = 54). No major complications occurred during follow-up. Multivariate Cox regression analyses revealed that AF type (other than long-standing persistent AF) and lack of hypertension were independently associated with maintenance of sinus rhythm (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.03 to 3.17, p = 0.04; HR: 0.49, 95% CI: 0.24 to 0.96, p = 0.04, respectively). LV systolic indices (LV ejection fraction, LV strain/strain rate at systole) and diastolic indices (E/E′, ratio of LV strain rate at diastole with early transmitral flow) were improved only in patients maintaining sinus rhythm at follow-up.
Conclusions Our results suggest that AF can be effectively and safely treated with a composite of repeat procedures and pharmaceuticals in patients with HFPEF. However, the current study was a single-arm analysis; therefore, larger randomized control studies are needed to verify the benefit of AF ablation in this cohort.
All the authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 8, 2013.
- Revision received July 1, 2013.
- Accepted July 9, 2013.
- American College of Cardiology Foundation