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PFA in heart failure patients: as safe and effective as in patients with healthy hearts?
Key messages
PFA is effective and without additional risk in IC patients.
Survival without atrial arrhythmia is significantly better in patients without HF, compared to those with HF with preserved or impaired LVEF, with no difference, however, between the 2 HF subtypes.
Introduction
AF and heart failure (HF) are often associated in the same patient, increasing morbidity and mortality.
While studies have shown the benefit of AF ablation in HF patients with reduced LVEF, the effect of electroporation-based AF ablation in these same patients is unknown.
Methodology and results
MANIFEST-PF is a prospective multicenter registry including patients who have undergone ablation of paroxysmal or persistent AF, by electroporation.
In this substudy, patients were divided into 3 groups: group 1: no IC; group 2: HF with preserved LVEF (≥50%); HF with altered LVEF (
Among the 1381 patients included, 85% (n=1174) had no HF, while 6.2% (n=87) had HF with preserved LVEF and 8.6% (n=120) had HF with LVEF. altered. HF patients had persistent AF more frequently than the non-HF group.
Survival at 1 year without atrial arrhythmia was significantly better in patients without HF, compared to those with HF with preserved or impaired LVEF (respectively 79.9%, 71.3%, 67.5%, p
However, major complications were not significantly higher in the IC subgroup.
Figure 1
Conclusion
Electroporation is effective and is not accompanied by an increased risk of complications in IC patients.
Survival without atrial arrhythmia is significantly better in patients without HF, compared to those with HF with preserved or impaired LVEF, with no difference, however, between the 2 HF subtypes.
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