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Scientific article
Review
Open access
English

Safety, efficacy and prognostic benefit of atrial fibrillation ablation in heart failure with preserved ejection fraction

Published inArrhythmia & electrophysiology review, vol. 11, e18
Publication date2022-09-14
First online date2022-09-14
Abstract

Up to 65% of patients with heart failure with preserved ejection fraction (HFpEF) develop AF during the course of the disease. This occurrence is associated with adverse outcomes, including pump failure death. Because AF and HFpEF are mutually reinforcing risk factors, sinus rhythm restoration may represent a disease-modifying intervention. While catheter ablation exhibits acceptable safety and efficacy profiles, no randomised trials have compared AF ablation with medical management in HFpEF. However, catheter ablation has been reported to result in lower natriuretic peptides, lower filling pressures, greater peak cardiac output and improved functional capacity in HFpEF. There is growing evidence that catheter ablation may reduce HFpEF severity, hospitalisation and mortality compared to medical management. Based on indirect evidence, early catheter ablation and minimally extensive atrial injury should be favoured. Hence, individualised ablation strategies stratified by stepwise substrate inducibility provide a logical basis for catheter-based rhythm control in this heterogenous population. Randomised trials are needed for definitive evidence-based guidelines.

eng
Keywords
  • AF
  • Catheter ablation
  • Heart failure
  • Heart failure with preserved ejection fraction
  • Pulmonary vein isolation
  • Rhythm control.
Citation (ISO format)
JOHNER, Nicolas, NAMDAR, Mehdi, SHAH, Dipen. Safety, efficacy and prognostic benefit of atrial fibrillation ablation in heart failure with preserved ejection fraction. In: Arrhythmia & electrophysiology review, 2022, vol. 11, p. e18. doi: 10.15420/aer.2022.10
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Article (Published version)
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ISSN of the journal2050-3369
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