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HFpEF reverses in more than a quarter of patients after thoracoscopic AF ablation

Session Poster Session 2

Speaker Athina Margarita Kougioumtzoglou

Event : ESC Congress 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Cardiovascular Surgery – Arrhythmias
  • Session type : Poster Session

Authors : AM Kougioumtzoglou (Amsterdam,NL), J Neefs (Amsterdam,NL), R Wesselink (Amsterdam,NL), MM Terpstra (Amsterdam,NL), NWE Van Den Berg (Amsterdam,NL), WR Berger (Amsterdam,NL), ER Meulendijks (Amsterdam,NL), SPJ Krul (Amsterdam,NL), FR Piersma (Amsterdam,NL), JSSG De Jong (Amsterdam,NL), WJP Van Boven (Amsterdam,NL), AHG Driessen (Amsterdam,NL), JR De Groot (Amsterdam,NL)

Authors:
A.M. Kougioumtzoglou1 , J. Neefs1 , R. Wesselink1 , M.M. Terpstra1 , N.W.E. Van Den Berg1 , W.R. Berger2 , E.R. Meulendijks1 , S.P.J. Krul1 , F.R. Piersma1 , J.S.S.G. De Jong2 , W.J.P. Van Boven1 , A.H.G. Driessen1 , J.R. De Groot1 , 1Amsterdam UMC, location AMC - Amsterdam - Netherlands (The) , 2Hospital Onze Lieve Vrouwe Gasthuis - Amsterdam - Netherlands (The) ,

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 1132

Purpose: To evaluate the proportion of patients in whom parameters that define the diagnosis of HFpEF and HFmrEF persist versus normalize upon elimination of AF.

Background: Atrial fibrillation (AF) and heart failure with preserved or mid-range ejection fraction (HFpEF or HFmrEF) concur in many patients. Distinction between these two diagnoses remains challenging as one can cause or exacerbate the other. Adequate patient selection for invasive AF treatment is crucial to improve rhythm outcome.

Methods: Patients underwent thoracoscopic ablation, consisting of pulmonary vein isolation (PVI) alone or PVI with additional lines in the case of persistent AF. Patients were prospectively followed-up. HFmrEF or HFpEF was defined as left ventricular ejection fraction (LVEF) ≥40% or ≥50% respectively and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels >125 pg/ml. Patients who remained free from AF, or any atrial tachycardia of more than 30 seconds, at 6 months postoperatively, were included in this study. Patients with AF recurrences during this period were excluded. The primary outcome was the change of NT-proBNP at 6 month follow-up.

Results: From 2008 to 2017, 92 patients undergoing thoracoscopic AF ablation fulfilled the aforementioned criteria and were included. Of these patients, mean age was 61±8 years and 66 (72%) were male. Median NT-proBNP was 366 pg/ml (128–2916) and mean LVEF was 53±7%. Thirty (35%) patients had a LVEF of 40–49%. Six months after elimination of AF, NT-proBNP was <125 pg/ml (Figure 1A: median 87 (50–122) vs 459 (137 – 2916) pg/ml at baseline; p<0.001) in 26 patients (28%), whereas in the remaining patients NT-proBNP was unchanged (Figure 1B: median 298 (126–1568) vs. 318 (128–2387) pg/ml at baseline; p=0.011).

Conclusion: In 28% of patients the diagnostic criteria of HFpEF/HFmrEF are caused by AF and normalize upon elimination of AF with thoracoscopic ablation.

Figure 1. NT-proBNP alterations after thoracoscopic AF ablation from baseline to 6 month follow-up. A. Patients with normalization of NT-proBNP. B. Patients with unchanged high levels of NT-proBNP.

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