Catheter Cryoballoon Ablation for Atrial Fibrillation: Focus on Men and Women with Chronic Heart Failure and Preserved Ejection Fraction

Background

Atrial fibrillation (AF) and chronic heart failure with preserved ejection fraction (CHFpEF) are frequently coexisting and mutually aggravating conditions. Data regarding the impact of catheter-based pulmonary vein isolation in AF patients with CHFpEF, particularly among men and women, remain limited.

Aim

To study the course of CHFpEF in male and female patients with atrial fibrillation during the early period after cryoballoon ablation of pulmonary veins (CBAPV).

Methods

CBAPV performed in 59 patients with AF and CHFpEF. Patients were divided by gender. Before surgery and three months postoperatively, quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ); functional status was evaluated via a six-minute walk test (6MWT); levels of NT-proBNP were measured; ECHO was conducted.

Results

There were differences between patient groups based on age: females (n = 34) had an average age of 67.62 ± 6.05 years compared to males (n = 25) who averaged 62.76 ± 7.29 years (p = 0.007). Groups did not differ significantly in terms of body mass index (BMI), duration and type of AF, class of HF, antiarrhythmic therapy, or treatment for HF. In the female group, there was a reduction in MLHFQ scores from 28.00 [25.00; 39.00] to 16.00 [8.00; 23.00] (p = 0.002), an increase in walking distance during the 6MWT from 397.00 [350.00; 440.00] to 425.00 [400.00; 465.00] meters (p 0.001), and a decrease in NT-proBNP levels from 185.00 [69.00; 517.00] ng/L to 126.00 [62.90; 196.00] ng/L (p = 0.015). Among males, the distance covered during the 6MWT increased from 464.00 [402.50; 560.25] meters to 500.00 [450.25; 581.50] meters (p = 0.003), while ECHO showed a reduction in the E/e' ratio from 9.00 [8.05; 9.70] to 8.00 [5.70; 9.00] (p = 0.033). One woman (4.3%) developed hemopericardium threatening cardiac tamponade, requiring pericardiocentesis as a serious complication.

Conclusion

Three months following catheter cryoballoon ablation of pulmonary veins, female patients with AF and CHFpEF experienced improvements in QoL, increased exercise capacity, and reduced NT-proBNP levels, indicating improvement in their condition. Male patients also increased exercise tolerance and decreased diastolic dysfunction severity over this same timeframe.