Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis

Mohit K Turagam; Petr Neuzil; Boris Schmidt; Tobias Reichlin; Kars Neven; Andreas Metzner; Jim Hansen; Yuri Blaauw; Philippe Maury; Thomas Arentz; Philipp Sommer; Ante Anic; Frederic Anselme; Serge Boveda; Tom Deneke; Stephan Willems; Pepijn van der Voort; Roland Tilz; Moritoshi Funasako; Daniel Scherr; Reza Wakili; Daniel Steven; Josef Kautzner; Johan Vijgen; Pierre Jais; Jan Petru; Julian Chun; Laurent Roten; Anna Füting; Marc D Lemoine; Martin Ruwald; Bart A Mulder; Anne Rollin; Heiko Lehrmann; Thomas Fink; Zrinka Jurisic; Corentin Chaumont; Raquel Adelino; Karin Nentwich; Melanie Gunawardene; Alexandre Ouss; Christian-Hendrik Heeger; Martin Manninger; Jan-Eric Bohnen; Arian Sultan; Petr Peichl; Pieter Koopman; Nicolas Derval; Thomas Kueffer; Nico Reinsch; MANIFEST-PF Cooperative

doi:10.1016/j.jacep.2024.05.002

Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis

Mohit K Turagam, Petr Neuzil, Boris Schmidt, Tobias Reichlin, Kars Neven, Andreas Metzner, Jim Hansen, Yuri Blaauw, Philippe Maury, Thomas Arentz, Philipp Sommer, Ante Anic, Frederic Anselme, Serge Boveda, Tom Deneke, Stephan Willems, Pepijn van der Voort, Roland Tilz, Moritoshi Funasako, Daniel ScherrReza Wakili, Daniel Steven, Josef Kautzner, Johan Vijgen, Pierre Jais, Jan Petru, Julian Chun, Laurent Roten, Anna Füting, Marc D Lemoine, Martin Ruwald, Bart A Mulder, Anne Rollin, Heiko Lehrmann, Thomas Fink, Zrinka Jurisic, Corentin Chaumont, Raquel Adelino, Karin Nentwich, Melanie Gunawardene, Alexandre Ouss, Christian-Hendrik Heeger, Martin Manninger, Jan-Eric Bohnen, Arian Sultan, Petr Peichl, Pieter Koopman, Nicolas Derval, Thomas Kueffer, Nico Reinsch, MANIFEST-PF Cooperative

Department of Cardiology

17 Citations (Scopus)

Abstract

BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF.

METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFPEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HFMR/REF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively.

RESULTS: Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HFPEF, and 8.6% (n=120) were HFMR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFPEF or HFMR/REF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HFMR/REF and HFPEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFPEF vs HFMR/REF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HFPEF and HFMR/REF groups (1.9%, 0%, and 2.5%, respectively).

CONCLUSION: PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.

Original language	English
Journal	JACC. Clinical electrophysiology
Volume	10
Issue number	7
Pages (from-to)	1675-1686
Number of pages	12
ISSN	2405-5018
DOIs	https://doi.org/10.1016/j.jacep.2024.05.002
Publication status	Published - Jul 2024

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10.1016/j.jacep.2024.05.002

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Turagam, M. K., Neuzil, P., Schmidt, B., Reichlin, T., Neven, K., Metzner, A., Hansen, J., Blaauw, Y., Maury, P., Arentz, T., Sommer, P., Anic, A., Anselme, F., Boveda, S., Deneke, T., Willems, S., van der Voort, P., Tilz, R., Funasako, M., ... MANIFEST-PF Cooperative (2024). Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis. JACC. Clinical electrophysiology, 10(7), 1675-1686. https://doi.org/10.1016/j.jacep.2024.05.002

Turagam, MK, Neuzil, P, Schmidt, B, Reichlin, T, Neven, K, Metzner, A, Hansen, J, Blaauw, Y, Maury, P, Arentz, T, Sommer, P, Anic, A, Anselme, F, Boveda, S, Deneke, T, Willems, S, van der Voort, P, Tilz, R, Funasako, M, Scherr, D, Wakili, R, Steven, D, Kautzner, J, Vijgen, J, Jais, P, Petru, J, Chun, J, Roten, L, Füting, A, Lemoine, MD, Ruwald, M, Mulder, BA, Rollin, A, Lehrmann, H, Fink, T, Jurisic, Z, Chaumont, C, Adelino, R, Nentwich, K, Gunawardene, M, Ouss, A, Heeger, C-H, Manninger, M, Bohnen, J-E, Sultan, A, Peichl, P, Koopman, P, Derval, N, Kueffer, T, Reinsch, N & MANIFEST-PF Cooperative 2024, 'Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis', JACC. Clinical electrophysiology, vol. 10, no. 7, pp. 1675-1686. https://doi.org/10.1016/j.jacep.2024.05.002

@article{f16800eef0c24dc18a45cf2fd1c78697,

title = "Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis",

abstract = "BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF.METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFPEF; LVEF≥50\%) or HF with reduced/mildly-reduced EF (HFMR/REF; LVEF<50\%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively.RESULTS: Of the 1,381 patients, 85\% (n=1,174) were no-HF, 6.2\% (n=87) were HFPEF, and 8.6\% (n=120) were HFMR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFPEF or HFMR/REF (79.9\%, 71.3\%, 67.5\%, p<0.001), but similar between HFMR/REF and HFPEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFPEF vs HFMR/REF for those with PAF (82.8\%/82.4\%/71.7\%, p=0.09) and PerAF (73.3\%, 64.2\%, and 64.9\%, p=0.14.MAE rates were similar between the no-HF, HFPEF and HFMR/REF groups (1.9\%, 0\%, and 2.5\%, respectively).CONCLUSION: PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.",

author = "Turagam, \{Mohit K\} and Petr Neuzil and Boris Schmidt and Tobias Reichlin and Kars Neven and Andreas Metzner and Jim Hansen and Yuri Blaauw and Philippe Maury and Thomas Arentz and Philipp Sommer and Ante Anic and Frederic Anselme and Serge Boveda and Tom Deneke and Stephan Willems and \{van der Voort\}, Pepijn and Roland Tilz and Moritoshi Funasako and Daniel Scherr and Reza Wakili and Daniel Steven and Josef Kautzner and Johan Vijgen and Pierre Jais and Jan Petru and Julian Chun and Laurent Roten and Anna F{\"u}ting and Lemoine, \{Marc D\} and Martin Ruwald and Mulder, \{Bart A\} and Anne Rollin and Heiko Lehrmann and Thomas Fink and Zrinka Jurisic and Corentin Chaumont and Raquel Adelino and Karin Nentwich and Melanie Gunawardene and Alexandre Ouss and Christian-Hendrik Heeger and Martin Manninger and Jan-Eric Bohnen and Arian Sultan and Petr Peichl and Pieter Koopman and Nicolas Derval and Thomas Kueffer and Nico Reinsch and \{MANIFEST-PF Cooperative\}",

note = "Copyright {\textcopyright} 2024. Published by Elsevier Inc.",

year = "2024",

month = jul,

doi = "10.1016/j.jacep.2024.05.002",

language = "English",

volume = "10",

pages = "1675--1686",

journal = "JACC. Clinical electrophysiology",

issn = "2405-5018",

publisher = "Elsevier USA",

number = "7",

}

TY - JOUR

T1 - Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure

T2 - A MANIFEST-PF Sub-analysis

AU - Turagam, Mohit K

AU - Neuzil, Petr

AU - Schmidt, Boris

AU - Reichlin, Tobias

AU - Neven, Kars

AU - Metzner, Andreas

AU - Hansen, Jim

AU - Blaauw, Yuri

AU - Maury, Philippe

AU - Arentz, Thomas

AU - Sommer, Philipp

AU - Anic, Ante

AU - Anselme, Frederic

AU - Boveda, Serge

AU - Deneke, Tom

AU - Willems, Stephan

AU - van der Voort, Pepijn

AU - Tilz, Roland

AU - Funasako, Moritoshi

AU - Scherr, Daniel

AU - Wakili, Reza

AU - Steven, Daniel

AU - Kautzner, Josef

AU - Vijgen, Johan

AU - Jais, Pierre

AU - Petru, Jan

AU - Chun, Julian

AU - Roten, Laurent

AU - Füting, Anna

AU - Lemoine, Marc D

AU - Ruwald, Martin

AU - Mulder, Bart A

AU - Rollin, Anne

AU - Lehrmann, Heiko

AU - Fink, Thomas

AU - Jurisic, Zrinka

AU - Chaumont, Corentin

AU - Adelino, Raquel

AU - Nentwich, Karin

AU - Gunawardene, Melanie

AU - Ouss, Alexandre

AU - Heeger, Christian-Hendrik

AU - Manninger, Martin

AU - Bohnen, Jan-Eric

AU - Sultan, Arian

AU - Peichl, Petr

AU - Koopman, Pieter

AU - Derval, Nicolas

AU - Kueffer, Thomas

AU - Reinsch, Nico

AU - MANIFEST-PF Cooperative

PY - 2024/7

Y1 - 2024/7

N2 - BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF.METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFPEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HFMR/REF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively.RESULTS: Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HFPEF, and 8.6% (n=120) were HFMR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFPEF or HFMR/REF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HFMR/REF and HFPEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFPEF vs HFMR/REF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HFPEF and HFMR/REF groups (1.9%, 0%, and 2.5%, respectively).CONCLUSION: PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.

AB - BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).OBJECTIVE: To assess the outcomes of pulsed-field ablation (PFA) in HF.METHODS: MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFPEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HFMR/REF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively.RESULTS: Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HFPEF, and 8.6% (n=120) were HFMR/REF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFPEF or HFMR/REF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HFMR/REF and HFPEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFPEF vs HFMR/REF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HFPEF and HFMR/REF groups (1.9%, 0%, and 2.5%, respectively).CONCLUSION: PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.

UR - https://www.scopus.com/pages/publications/85195494397

U2 - 10.1016/j.jacep.2024.05.002

DO - 10.1016/j.jacep.2024.05.002

M3 - Journal article

C2 - 38869506

SN - 2405-5018

VL - 10

SP - 1675

EP - 1686

JO - JACC. Clinical electrophysiology

JF - JACC. Clinical electrophysiology

IS - 7

ER -

Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis

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