The rhythm control strategy in patients with atrial fibrillation and heart failure with preserved or reduced ejection fraction: the single centre experience

A rhythm control strategy may provide survival benefit for patients with HF.

Of our study is to analyze the outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction.

Patients with incident AF occurring during 2024 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF < 50% were designated as HF and reduced ejection fraction (HFrEF). Rhythm control in the first year after AF diagnosis was defined as prescriptions for an antiarrhythmic drug, catheter ablation, or maze procedure. The primary endpoint was all-cause mortality. The secondary endpoints were cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack.

A pilot study included 121 patients with atrial fibrillation, mostly men (66% or 46 patients), average age of 76.12 ± 9.66 years. HFpEF was recorded in 87.4% or 105 patients and HFrEF was recorded in 12.6% or 16 patients. Rhythm control strategy was adopted in 19% or 23 patients with HF, mostly in the HFpEF group (18% or 19 patients). There was no difference in all-cause 1- year mortality between the subgroup according to achieved rhythm control strategy in HFpEF and HFrEF groups respectively. Among the patients with HFpEF, subgroup with achieved rhythm control had no incidence of cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack. Among the patients with HFpEF and rate control strategy the incidence of stroke or transient ischemic attack was significantly higher (11.4% or 12 patients) as well as cardiovascular hospitalization (9.8% or 10 patients) (p <0.001, p <0.001).

Although rhythm control strategy was seldom adopted in patients with HF and AF it may provide survival benefit for patients with HFpEF-AF.