ATHENA-register: pulsed field ablatie voor atriumfibrilleren ook effectief bij hartfalen, vooral paroxismaal

BACKGROUND: Data on pulsed-field ablation (PFA) for atrial fibrillation (AF) in patients with heart failure (HF) are limited. OBJECTIVE: To evaluate clinical outcomes of PFA in patients with AF and HF, stratified by HF subtype. METHODS: Consecutive patients undergoing first-time pentaspline PFA within the ATHENA registry were analyzed. Patients were stratified into three groups: no HF, HF with preserved ejection fraction (HFpEF, LVEF ≥50%), and HF with mildly reduced or reduced EF (HFmrEF/rEF, LVEF <50%). The primary endpoint was freedom from documented atrial arrhythmias >30 seconds after a 2-month blanking period. AAD use was left to physician discretion. RESULTS: Among 1,224 patients included (68.5% with paroxysmal AF and 31.5% with persistent AF), 176 (14.4%) had HF: 40 (3.3%) with HFpEF and 136 (11.1%) with HFmrEF/rEF. The Kaplan-Meier estimated freedom from any atrial arrhythmias at 1-year follow-up was 79.9%, with higher rate in the no-HF group (81.0%) vs the HF group (73.3%, HR=1.5, 95%CI: 1.1-2.1, p=0.0133). Considering separately paroxysmal and persistent AF form, paroxysmal AF patients with no sign of HF showed significantly higher freedom from atrial arrhythmias (82.2%) than patients with HF (68.6%, 2.0, 1.3-3.1, p=0.0028), while no differences were found in patients with persistent AF (77.9% vs 76.4%, 1.1, 0.7-1.7, p=0.7065). CONCLUSION: PFA with the pentaspline catheter appears to be an effective treatment for AF in patients with HF. Freedom from AF and atrial arrhythmias post-PFA was highest in patients with paroxysmal AF and no history of HF, with no significant differences observed in persistent AF patients.