AUTHOR=Kim Min , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , Joung Boyoung , Lee Moon-Hyoung , Pak Hui-Nam 

TITLE=One-Year Change in the H2FPEF Score After Catheter Ablation of Atrial Fibrillation in Patients With a Normal Left Ventricular Systolic Function

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.699364

DOI=10.3389/fcvm.2021.699364

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> It is unclear whether atrial fibrillation (AF) catheter ablation (AFCA) improves the left ventricular (LV) diastolic function. We evaluated the 1-year change in the H<sub>2</sub>FPEF score, which reflects the degree of LV diastolic function, after AFCA among patients with a normal LV systolic function.</p><p><bold>Methods and Results:</bold> We included 1,471 patients (30.7% female, median age 60 years, paroxysmal-type AF 68.6%) who had available H<sub>2</sub>FPEF scores at baseline and at 1-year after AFCA to evaluate the 1-year change in the H<sub>2</sub>FPEF score (ΔH<sub>2</sub>FPEF score<sub>[1−yr]</sub>) after AFCA. Baseline high H<sub>2</sub>FPEF scores (≥6) were independently associated with the female sex, left atrium (LA) diameter, LV mass index, pericardial fat volume, and a low estimated glomerular filtration rate. One year after AFCA, decreased ΔH<sub>2</sub>FPEF scores<sub>[1−yr]</sub> were associated with baseline H<sub>2</sub>FPEF scores of ≥6 [OR, 4.19 (95% CI, 2.88–6.11), <italic>p</italic> &lt; 0.001], no diabetes [OR, 0.60 (95% CI, 0.37–0.98), <italic>p</italic> = 0.04], and lower pericardial fat volume [OR, 0.99 (95% CI, 0.99–1.00), <italic>p</italic> = 0.003]. Increased ΔH<sub>2</sub>FPEF scores<sub>[1−yr]</sub> were associated with a baseline H<sub>2</sub>FPEF score of &lt;6 [OR, 3.54 (95% CI, 2.08–6.04), <italic>p</italic> &lt; 0.001] and sustained AF after a recurrence within 1 year [SustainAF<sub>[1−yr]</sub>; OR, 1.89 (95% CI, 1.01–3.54), <italic>p</italic> = 0.048]. Throughout a 56-month median follow-up, an increased ΔH<sub>2</sub>FPEF score<sub>[1−yr]</sub> resulted in a poorer rhythm outcome of AFCA (at 1 year, log-rank <italic>p</italic> = 0.003; long-term, log-rank <italic>p</italic> = 0.010).</p><p><bold>Conclusions:</bold> AFCA appears to improve LV diastolic dysfunction. However, SustainAF<sub>[1−yr]</sub> may contribute to worsening LV diastolic dysfunction, and it was shown by increased ΔH<sub>2</sub>FPEF scores<sub>[1−yr]</sub>, which was independently associated with higher risk of AF recurrence rate after AFCA.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> Identifier: NCT02138695.</p>