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Title: | Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients With Heart Failure | Authors: | Turagam, Mohit K. Neuzil, Petr Schmidt, Boris Reichlin, Tobias Neven , Kars Metzner, Andreas Hansen , Jim Blaauw, Yuri Maury, Philippe Arentz, Thomas Sommer, Philipp Anic, Ante Anselme, Frederic Boveda, Serge Deneke, Tom Willems , Stephan van der Voort, Pepijn Tilz, Roland Funasako, Moritoshi Scherr, Daniel Wakili, Reza Steven, Daniel Kautzner, Josef VIJGEN, Johan Jais, Pierre Petru, Jan Chun, Julian Roten, Laurent Fueting, Anna Lemoine, Marc D. Ruwald, Martin Mulder, Bart A. Rollin, Anne Lehrmann, Heiko Fink, Thomas Jurisic, Zrinka Chaumont, Corentin Adelino, Raquel Nentwich, Karin Gunawardene, Melanie Ouss, Alexandre Heeger, Christian-Hendrik Manninger, Martin Bohnen, Jan-Eric Sultan, Arian Peichl, Petr KOOPMAN, Pieter Derval, Nicolas Kueffer, Thomas Reinsch, Nico Reddy, Vivek Y. |
Issue Date: | 2024 | Publisher: | ELSEVIER | Source: | JACC. Clinical electrophysiology (Print), 10 (7) , p. 1675 -1686 | Abstract: | 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). OBJECTIVES This study sought to assess the outcomes of pulsed field ablation (PFA) in HF. METHODS MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-Approval Clinical Use of Pulsed Field Ablation) is a multicenter, patient-level registry of consecutive patients undergoing PFA for paroxysmal AF or persistent AF (PerAF). In this substudy, patients were stratified as no history of HF (no-HF), HF with preserved EF (HFpEF) (left ventricular EF of >= 50%) or HF with reduced/mildly reduced EF (HFmr/rEF) (left ventricular EF of <50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting >= 30 seconds and major adverse events, 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 > 0.99). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF patients than in those with HFpEF or HFmr/rEF (79.9%, 71.3%, and 67.5%, respectively; P < 0.001) but similar between patients with 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 paroxysmal AF (82.8%, 82.4%, and 71.7%, respectively; P = 0.09) and PerAF (73.3%, 64.2%, and 64.9%, respectively; P = 0.14). Major adverse event rates were similar between the no-HF, HFpEF, and HFmr/rEF groups (1.9%, 0%, and 2.5%, respectively). CONCLUSIONS 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. (JACC Clin Electrophysiol 2024;10:1675-1686) (c) 2024 by the American College of Cardiology Foundation. | Notes: | Reddy, VY (corresponding author), Icahn Sch Med Mt Sinai, Mt Sinai Fuster Heart Hosp, Helmsley Electrophysiol Ctr, One Gustave L Levy Pl,POB 1030, New York, NY 10029 USA. vivek.reddy@mountsinai.org |
Keywords: | atrial fibrillation;heart failure;HFpEF;HFrEF;pulsed field ablation | Document URI: | http://hdl.handle.net/1942/43663 | ISSN: | 2405-500X | e-ISSN: | 2405-5018 | DOI: | 10.1016/j.jacep.2024.05.002 | ISI #: | 001285248000001 | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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