Analysis of guideline-directed medical therapy in patients with reduced ejection fraction undergoing pulsed field ablation for atrial fibrillation: a multicentre study
S Aminolsharieh Najafi, D Schaack, A Urbani, J Kheir, A Steyer, A Marx, J Lurz, M Gunawardene, B Schmidt, K R J Chun, L UrbanekAbstract
Background
Atrial fibrillation (AF) is highly prevalent among patients with heart failure with reduced ejection fraction (HFrEF), and is associated with adverse outcomes.
Purpose
This study aimed to assess adherence to guideline-directed medical therapy (GDMT) at the time of hospital admission in patients undergoing pulsed field ablation (PFA) for atrial fibrillation.
Methods
This retrospective, multicentre study included patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%) and concomitant atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI) between 2021 and 2024. Baseline characteristics and admission medications were systematically assessed and analyzed.
Results
Among 110 patients with HFrEF, mean age was 65.5 ± 10.5 years, 82.3% were male and most patients (79%) had persistent AF. Regarding comorbidities, arterial hypertension was present in 66%, diabetes mellitus in 12% , history of stroke or transient ischemic attack in 2.7% of patients and coronary artery disease in 31%.
At admission, β-blockers were prescribed in 80% of patients, ACE inhibitors, Angiotensin-II-Rezeptorblocker (ARBs), or Angiotensin-Rezeptor-Neprilysin-Inhibitor (ARNIs) in 70%, mineralocorticoid receptor antagonists (MRAs) in 46%, and SGLT2 inhibitors in 42%. Regarding GDMT optimization, the guideline-directed target dose was achieved in only 22% for ARNI/ARB/ACE-I therapy, 37% for MRA therapy, and 28% for β-blocker therapy.
Conclusion
Our study shows that among patients with HFrEF and AF, the prescription rates of β-blockers and renin–angiotensin system inhibitors (ARNI/ARB/ACE-I) were generally satisfying, whereas the use of MRAs and SGLT2 inhibitors remained suboptimal. Despite good overall adherence to GDMT, only a minority of patients achieved guideline-recommended target dose. These findings emphasize the need for improved optimization and implementation of medical treatment strategies in this high-risk population alogside Pulmonary vein Isolation.GMDT in HFrEF Patient with AF