TY - JOUR
T1 - Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients With Heart Failure
AU - MANIFEST-PF Cooperative
AU - Turagam, Mohit K.
AU - Neuzil, Petr
AU - Schmidt, Boris
AU - Reichlin, Tobias
AU - Neven, Kars
AU - Metzner, Andreas
AU - Hansen, Jim
AU - Blaauw, Yuri
AU - Maury, Philippe
AU - Arentz, Thomas
AU - Sommer, Philipp
AU - Anic, Ante
AU - Anselme, Frederic
AU - Boveda, Serge
AU - Deneke, Tom
AU - Willems, Stephan
AU - van der Voort, Pepijn
AU - Tilz, Roland
AU - Funasako, Moritoshi
AU - Scherr, Daniel
AU - Wakili, Reza
AU - Steven, Daniel
AU - Kautzner, Josef
AU - Vijgen, Johan
AU - Jais, Pierre
AU - Petru, Jan
AU - Chun, Julian
AU - Roten, Laurent
AU - Füting, Anna
AU - Lemoine, Marc D.
AU - Ruwald, Martin
AU - Mulder, Bart A.
AU - Rollin, Anne
AU - Lehrmann, Heiko
AU - Fink, Thomas
AU - Jurisic, Zrinka
AU - Chaumont, Corentin
AU - Adelino, Raquel
AU - Nentwich, Karin
AU - Gunawardene, Melanie
AU - Ouss, Alexandre
AU - Heeger, Christian Hendrik
AU - Manninger, Martin
AU - Bohnen, Jan Eric
AU - Sultan, Arian
AU - Peichl, Petr
AU - Koopman, Pieter
AU - Derval, Nicolas
AU - Kueffer, Thomas
AU - Reinsch, Nico
AU - Reddy, Vivek Y
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - atrial fibrillation
KW - heart failure
KW - HFpEF
KW - HFrEF
KW - pulsed field ablation
UR - http://www.scopus.com/inward/record.url?scp=85195494397&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2024.05.002
DO - 10.1016/j.jacep.2024.05.002
M3 - Article
C2 - 38869506
AN - SCOPUS:85195494397
SN - 2405-500X
VL - 10
SP - 1675
EP - 1686
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 7
ER -