Department of Medicine II, Ulm University Medical Center, Albert Einstein Allee 23, 89081 Ulm, Germany.
Europace. 2020 Sep 1;22(9):1328-1336. doi: 10.1093/europace/euaa101.
Atrial fibrillation (AF) in patients suffering from heart failure with preserved ejection fraction (HFpEF) is associated with increased symptoms and higher morbidity and mortality. Effective treatment strategies for this patient population have not yet been established.
We analysed clinical outcomes and echocardiographic parameters of patients with AF and HFpEF who underwent pulmonary vein isolation (PVI). Out of 374 PVI patients, we identified 35 patients suffering from concomitant HFpEF. Freedom from atrial tachyarrhythmia (AT) after 1 year was 80%. Heart failure symptoms assessed by New York Heart Association class significantly improved from 2.7 ± 0.7 to 1.7 ± 0.9 (P < 0.001). We observed regression of diastolic dysfunction by echocardiography 12 months after the index procedure. Moreover, 15 patients (42.9%) experienced complete resolution of HFpEF after a single ablation procedure. Multivariate logistic regression revealed absence of AT recurrence as an independent predictor of recovery from HFpEF (hazard ratio 11.37, 95% confidence interval 1.70-75.84, P = 0.009). Furthermore, resolution of HFpEF by achieving freedom from AT recurrence by PVI, including multiple procedures, led to a significant reduction of hospitalizations.
Our results suggest that restoration of sinus rhythm by PVI in HFpEF patients with concomitant AF induces reverse remodelling, improvement of symptoms, resolution of HFpEF and subsequently decrease of hospitalizations. Randomized controlled trials are warranted to confirm our results.
射血分数保留的心力衰竭（HFpEF）合并心房颤动（AF）患者的症状更多，发病率和死亡率更高。对于这一患者群体，尚未建立有效的治疗策略。
我们分析了接受肺静脉隔离（PVI）的 AF 和 HFpEF 合并患者的临床结果和超声心动图参数。在 374 名 PVI 患者中，我们确定了 35 名患有合并 HFpEF 的患者。1 年后无房性快速心律失常（AT）的比例为 80%。纽约心脏协会（NYHA）心功能分级评估的心力衰竭症状显著改善，从 2.7±0.7 改善至 1.7±0.9（P<0.001）。我们在指数手术后 12 个月观察到舒张功能障碍的消退。此外，15 名患者（42.9%）在单次消融后完全缓解 HFpEF。多变量逻辑回归显示，AT 无复发是 HFpEF 恢复的独立预测因素（危险比 11.37，95%置信区间 1.70-75.84，P=0.009）。此外，通过 PVI 实现 AF 无复发来恢复窦性心律，包括多次手术，可显著减少住院。
我们的结果表明，HFpEF 合并 AF 患者通过 PVI 恢复窦性心律可引起逆重构、症状改善、HFpEF 缓解，并随后减少住院。需要进行随机对照试验来证实我们的结果。
