PhD Scientific Days 2023

Clinical Medicine II.

Efficacy of Early Pulmonary Vein Isolation in Patients with Heart Failure

Text of the abstract

Introduction
Atrial fibrillation (AF) and heart failure (HF) often coexist leading to worse outcomes compared to AF or HF alone. According to the current guidelines, catheter ablation (CA) with pulmonary vein isolation (PVI) as first-line therapy should be considered, however, the optimal timing of the procedure is still unknown.

Aims
We aimed to investigate the effect of early PVI on AF recurrence and all-cause mortality in patients with HFrEF and HFmrEF.

Method
We analyzed the data of 334 patients with symptomatic paroxysmal or persistent AF and diagnosed HF with LVEF < 50% who underwent PVI between 2010 and 2022. The patients’ medical history, laboratory results, echocardiographic and periprocedural parameters were collected in a structured registry. Early PVI was defined as CA performed within 12 months of AF diagnosis. The minimum follow-up was 12 months. Our primary endpoint was AF recurrence-free survival and secondary endpoints were AF recurrence after a 3-months blanking period and all-cause mortality at any time during follow-up.

Results
Among the 334 patients, 164 (49%) experienced AF recurrence and 86 (26%) patients died during the follow-up period. The median age was 63 (57-70) years. In our study population, 119 (36%) patients had paroxysmal AF, while 213 patients had persistent AF. The median LVEF was 40% for early PVI and 38% for deferred PVI. Early PVI was a predictor of AF recurrence-free survival (HR: 0.42 [0.31-0.57], p<0.001). Patients who underwent early PVI had lower recurrence-rate (26% for early, 66% for delayed PVI). Early ablation was not associated with mortality benefit. Early PVI was not identified as a mortality predictor neither in paroxysmal AF nor in the persistent AF group. Reablation was performed in 66 (40%) cases. Patients who underwent redo PVI were associated with better survival (HR=0.29 [0.11-0.79], p<0.001), although selection bias can not be excluded.

Conclusion
Timing of PVI might be a key factor in patients with HF and AF. Early CA was associated with longer arrhythmia-free survival, however all-cause mortality was not affected. In case of arrhythmia recurrence, selected patients may benefit from repeat ablation.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.