BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF). OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF. METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFPEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HFMR/REF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively. RESULTS: Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HFPEF, and 8.6% (n=120) were HFMR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFPEF or HFMR/REF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HFMR/REF and HFPEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFPEF vs HFMR/REF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HFPEF and HFMR/REF groups (1.9%, 0%, and 2.5%, respectively). CONCLUSION: PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.

Asklepios Hospital St Georg Hamburg Germany

Cardiology Department Na Homolce Hospital Homolka Hospital Prague Czechia

Cardiology Department Na Homolce Hospital Homolka Hospital Prague Czechia;; Neuron Medical Brno Czech Republic

Catharina Hospital Eindhoven The Netherlands instead of Catharina Ziekenhuis Eindhoven The Netherlands

Clinic for Electrophysiology Herz und Diabeteszentrum NRW Ruhr University Bochum Bad Oeynhausen Germany

Department for Cardiovascular Diseases University Hospital Center Split Split Croatia

Department of Cardiology and Angiology Medical Center and Faculty of Medicine University of Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center Essen University Duisburg Essen Duisburg Germany

Department of Cardiology Herlev Gentofte University Hospital Hellerup Denmark

Department of Cardiology Jessa Hospitals Hasselt Belgium

Department of Cardiology Rouen Hospital Rouen France

Department of Cardiology University Hospital Rangueil Toulouse France

Department of Cardiology University Hospital Rangueil Toulouse France;; I2MC INSERM UMR 1297 Toulouse France

Department of Cardiology University of Groningen University Medical Center Groningen Groningen The Netherlands

Department of Medicine Witten Herdecke University Witten Germany;; Department of Electrophysiology Alfried Krupp Hospital Essen Germany

Division of Cardiology Department of Internal Medicine Medical University of Graz Graz Austria

Heart Center Bad Neustadt Rhoen Clinic Campus Bad Neustadt Bad Neustadt an der Saale Germany

Heart Center University Hospital of Cologne Department for Electrophysiology Cologne Germany

Heart Rhythm Department Clinique Pasteur Toulouse France;; Universitair Ziekenhuis VUB Brussels Belgium

Icahn School of Medicine at Mount Sinai New York NY USA

Icahn School of Medicine at Mount Sinai New York NY USA;; Cardiology Department Na Homolce Hospital Homolka Hospital Prague Czechia;

IHU LIRYC CHU Bordeaux University of Bordeaux Bordeaux France

IKEM Institute for Clinical and Experimental Medicine Prague Czech Republic

Inselspital Bern University Hospital University of Bern Bern Switzerland

MVZ CCB Frankfurt und Main Taunus GbR Frankfurt Germany

University Heart and Vascular Center University Medical Center Hamburg Eppendorf Hamburg Germany

University Heart Center Lübeck Department of Rhythmology University Hospital Schleswig Holstein Germany;; German Center for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Lübeck Germany

Citace poskytuje Crossref.org

Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation