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SHR Neuro Cancer Cardio Lipid Metab Microb

Turagam, MK; Neuzil, P; Schmidt, B; Reichlin, T; Neven, K; Metzner, A; Hansen, J; Blaauw, Y; Maury, P; Arentz, T; Sommer, P; Anic, A; Anselme, F; Boveda, S; Deneke, T; Willems, S; van, der, Voort, P; Tilz, R; Funasako, M; Scherr, D; Wakili, R; Steven, D; Kautzner, J; Vijgen, J; Jais, P; Petru, J; Chun, J; Roten, L; Füting, A; Lemoine, MD; Ruwald, M; Mulder, BA; Rollin, A; Lehrmann, H; Fink, T; Jurisic, Z; Chaumont, C; Adelino, R; Nentwich, K; Gunawardene, M; Ouss, A; Heeger, CH; Manninger, M; Bohnen, JE; Sultan, A; Peichl, P; Koopman, P; Derval, N; Kueffer, T; Reinsch, N; Reddy, VY, , MANIFEST-PF, Cooperative.
Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis.
JACC Clin Electrophysiol. 2024; Doi: 10.1016/j.jacep.2024.05.002
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Co-authors Med Uni Graz

Manninger-Wünscher Martin

Scherr Daniel

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Abstract:

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). OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF. METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HF_PEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HF_MR/REF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively. RESULTS: Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HF_PEF, and 8.6% (n=120) were HF_MR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HF_PEF or HF_MR/REF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HF_MR/REF and HF_PEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HF_PEF vs HF_MR/REF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HF_PEF and HF_MR/REF groups (1.9%, 0%, and 2.5%, respectively). CONCLUSION: 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.

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