Comparative changes in echocardiographic parameters and NT-proBNP levels after catheter ablation in patients with HF and persistent AF across HF phenotypes
M Jung, H S Park, J Hwang, T W ChungAbstract
Background
Atrial fibrillation (AF) and heart failure (HF) frequently coexist and adversely affect each other’s clinical course. However, data regarding functional improvement after radiofrequency catheter ablation (RFCA) of AF, including changes in echocardiographic parameters and NT-proBNP levels, remain limited.
Purpose
This study aimed to evaluate changes in echocardiographic parameters and NT-proBNP levels after RFCA in patients with persistent AF and HF, stratified according to HF phenotypes.
Methods
We retrospectively analyzed 331 patients with persistent AF and HF who underwent RFCA between January 2011 and March 2024 at our University Hospital. Patients were categorized into three phenotypes: HF with reduced (HFrEF, LVEF ≤40%, n=130), mildly reduced (HFmrEF, 41-49%, n=124), and preserved ejection fraction (HFpEF, ≥50%, n=77). Echocardiographic parameters and NT-proBNP levels before and after ablation were compared using paired t-tests within each HF phenotype. The mean follow-up intervals were 585.5±320.0 days for echocardiography and 448.9±522.5 days for NT-proBNP.
Results
After RFCA, LVEF significantly improved in HFrEF (32.6 → 47.5%, p<0.001) and HFmrEF (47.8 → 52.5%, p<0.001), but not in HFpEF (58.7 → 57.7%, p=0.373). Left atrial diameter (LAD) and left atrial volume index (LAVI) decreased significantly across all phenotypes (p<0.05 for all), indicating favorable atrial adverse remodeling. Right ventricular systolic pressure and TR Vmax showed no significant change except for a mild increase in TR Vmax in HFrEF. NT-proBNP levels markedly decreased after ablation in all groups (HFrEF: 1183 → 667 pg/mL; HFmrEF: 915 → 559 pg/mL; HFpEF: 539 → 425 pg/mL; p<0.001 for all).
Conclusion
In patients with persistent AF and HF, RFCA was associated with significant improvement in left ventricular systolic function and reduction in NT-proBNP levels across all HF phenotypes. Structural remodeling parameters such as LAD and LAVI also improved suggesting partial reverse remodeling of the left atrium after ablation.Table 1.Baseline characteristicsTable 2.Echo parameters and NT-proBNP