key findings

• a important proportion of patients undergoing afib ablation in the cabana trial had a high probability of hfpef.
• af ablation resulted in a lower risk for cardiovascular hospitalization or all-cause death in patients with a high probability of hfpef.
• af ablation improved functional status,with a slightly larger effect on nyha functional class reduction in patients with a high probability of hfpef.

methodology

researchers conducted a post hoc analysis of the cabana trial, which included 2,204 patients aged 65 years or older. the analysis focused on 1,763 patients whose modified h2fpef score could be calculated.a score of 6 or higher was defined as a high probability of hfpef.

the study assessed the prevalence of hfpef and the effect of af ablation on patients with a high probability of hfpef. endpoints included the risk for all-cause mortality and cardiovascular hospitalization, af recurrence, and functional status, as measured by nyha functional class and canadian cardiovascular society-af severity class.

detailed results

the analysis revealed that 55% of patients had a high probability of hfpef. these patients had a higher risk for af recurrence at follow-up (odds ratio, 1.1; p = .001) and tended to have a higher risk for cardiovascular hospitalization or all-cause death.

however, af ablation showed a significant benefit in this group. it resulted in a lower risk for cardiovascular hospitalization or all-cause death in patients with a high probability of hfpef (hazard ratio, 0.82; p = .025). this effect was not observed in those with a low probability of hfpef.

moreover, af ablation resulted in a lower risk for af recurrence in both patients with a low probability and those with a high probability of hfpef (p for interaction = .035). af ablation improved functional status, with a slightly larger effect on nyha functional class reduction seen in patients with a high probability of hfpef.

clinical implications

the study underscores the importance of identifying hfpef in patients undergoing afib ablation. according to the study authors, identifying patients with hfpef might allow for the initiation of disease-modifying therapies that are known to improve hfpef status.

limitations

the researchers noted several limitations.the h2fpef score could not be calculated for all patients due to missing data. additionally,h2fpef scores of 4 or 5 may not necessarily rule out hfpef. the observed benefits of af ablation may or may not be additive to those of emerging pharmacotherapies for hfpef.

faq

what is hfpef?

heart failure with preserved ejection fraction, a condition where the heart can pump blood effectively but has difficulty relaxing and filling.

what is afib ablation?

a procedure to treat atrial fibrillation by creating scar tissue in the heart to block abnormal electrical signals.

what is the cabana trial?

a large clinical trial comparing afib ablation to drug therapy for patients with atrial fibrillation.

how was hfpef probability determined in the study?

using the modified h2fpef score, with a score of 6 or higher indicating a high probability of hfpef.

what were the main benefits of afib ablation for patients with a high probability of hfpef?

lower risk of cardiovascular hospitalization or all-cause death, and improved functional status.