Background We aimed to compare the long-term outcomes of catheter ablation and medical treatment in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Methods We retrospectively screened consecutive patients with AF and HFpEF who received catheter ablation or medical treatment from December 2017 to June 2021 in our institution. The primary endpoint was defined as a composite of all-cause death, thromboembolic events and heart failure (HF) hospitalization. Multivariate analysis, 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to adjust for potential confounders. Results A total of 131 patients were included, among whom 71 patients (54.2%) underwent 1.15 + 0.36 catheter ablation procedures. During a median follow-up of 31.8 months, the incidence of the primary endpoint was significantly lower in catheter ablation group (9.9% vs 25.0%, log rank p = 0.018) compared with medical treatment group. In the multivariate model, catheter ablation was independently associated with a lower incidence of the primary endpoint (hazard ratio 0.281, 95% confidence interval 0.110 – 0.721, p = 0.008), which was consistent both in PSM and IPTW cohorts. The New York Heart Association class [2 (1, 2) vs 2 (2, 2), paired p < 0.001], N-terminal pro-B type natriuretic peptide level [334.3 (187.1, 821.8) vs 859.2 (308.4, 1903.0), paired p < 0.001] and left atrial diameter (39.4 + 6.4 vs 41.1 + 6.2, paired p = 0.001) were significantly improved at the end of follow-up in catheter ablation group. Conclusion Catheter ablation was significantly associated with a lower incidence of the composite endpoint, improved HF symptoms and reverse atrial remodeling in AF and concomitant HFpEF.

Background Optimal occlusion of pulmonary vein (PV) is essential for atrial fibrillation (AF) cryoballoon ablation (CBA). The aim of the study was to investigate the performance of two different tools for the assessment of PV occlusion with a novel navigation system in CBA procedure. Methods In consecutive patients with paroxysmal AF who underwent CBA procedure with the guidance of the novel 3-dimentional mapping system, the baseline tool, injection tool and pulmonary venography were all employed to assess the degree of PV occlusion, and the corresponding cryoablation parameters were recorded. Results In 23 patients (mean age 60.0 + 13.9 years, 56.5% male), a total of 149 attempts of occlusion and 122 cryoablations in 92 PVs were performed. Using pulmonary venography as the gold standard, the overall sensitivity, specificity of the baseline tool was 96.7% (95% CI 90.0% - 99.1%), and 40.5% (95% CI 26.0% - 56.7%), respectively, while the corresponding value of the injection tool was 69.6% (95% CI 59.7% - 78.1%), and 100.0% (95% CI 90.6% - 100.0%), respectively. Cryoablation with optimal occlusion showed lower nadir temperature (baseline tool: -44.3 + 8.4 ℃ vs -35.1 + 6.5 ℃, p < 0.001; injection tool: -46.7 + 6.4 ℃ vs -38.3 + 9.2 ℃, p < 0.001) and longer total thaw time (baseline tool: 53.3 + 17.0 s vs 38.2 + 14.9 s, p = 0.003; injection tool: 58.5 + 15.5 s vs 41.7 + 15.2 s, p < 0.001) compared with those without. Conclusions Both tools were able to accurately assess the degree of PV occlusion and predict the acute cryoablation effect, with the baseline tool being more sensitive and the injection tool more specific.