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Association of the H2FPEF Risk Score with Recurrence of Atrial Fibrillation Following Pulmonary Vein Isolation

Background: While atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist, the efficacy of pulmonary vein isolation in the setting of HFpEF is unclear. Methods: In a cohort of patients who underwent cryoballoon ablation (CBA) from 2011 to 2016, we calculated the H2FPEF risk score, a novel 6-item score (scale: 0-9 points) that accurately predicts the probability of HFpEF. We compared characteristics of patients by H2FPEF score and evaluated the association of H2FPEF score with 12-month recurrence of AF post-procedure. Results: Of patients with available data to calculate the H2FPEF score (n=105), the median H2FPEF score was 5 (interquartile range: 4-6), corresponding to >80% probability of HFpEF. Compared to patients with H2FPEF scores ≤4 (n=34), patients with H2FPEF scores of 5 and 6 (n=46) and ≥7 (n=25) carried higher rates of hypertension (≤4: 21% vs. 5 and 6: 63% vs. ≥7: 88%, P<0.001) and diabetes (≤4: 0% vs. 5 and 6: 9% vs. ≥7: 32%, P=0.001). The overall 12-month recurrence rate of AF was 21%. There was no association between H2FPEF score and recurrence of AF at 12 months (OR per SD increase in log-H2FPEF score: 0.87, 95% CI: 0.54-1.40, P=0.57). Conclusion: Among patients undergoing CBA for AF, median H2FPEF scores are elevated, and screening for occult HFpEF may be warranted in this population. There was no association of the H2FPEF score and AF recurrence at 12 months, suggesting efficacy of CBA even among patients with high H2FPEF scores. Key Words: Atrial Fibrillation; Heart Failure With Preserved Ejection Fraction; Ablation; Recurrence; Risk Score

Credits: Ravi B. Patel MD, Caitlin Somerville BA , Fei Fei Gong MBBS , Andrew C. Peters MD , Sanjiv J. Shah MD , Alexandru B. Chicos MD , Susan Kim MD , Bradley P. Knight MD , Albert Lin MD , Nishant Verma MD MPH , Rod S. Passman MD MSCE

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