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2024 AF Symposium
The Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure: Part IV
This important Friday session had five speakers: Dr. Stephen Willems, Dr. Jason Andrade, Dr. Philipp Sommer, Dr. Douglas Packer and Dr. Francis Marchlinski.
Dr. Douglas Packer
Dr. Douglas Packer of the Intermountain Institute, Murray, UT, gave the fourth talk in what was described as the “most important session of the whole meeting,”
AF Ablation in Patients with Heart Failure and Preserved Ejection Fraction
Background: Heart Failure is when the heart ‘fails’ to pump enough blood to the other organs to satisfy their need for oxygen and nutrients. (A “failed” heart is NOT one that has suddenly stopped.)
Ejection Fraction Illustration; Source: Penn Medical
Ejection Fraction (EF) measures how well your heart is pumping, Normal EF is around 50%–75%. An EF ratio of less than 35% (<35) increases the risk of life-threatening irregular heartbeats.
5–6 Million in the U.S. Have Heart Failure
Dr. Packer began with a disturbing statistic. In the U.S. 5–6 million people have heart failure. He distinguished between 2 types of heart failure:
• Heart failure with “preserved” or minimally reduced ejection fraction [>50%] (HFpEF);
• Heart failure with reduced ejection fraction [<50%] (HFrEF).
Comparing Preserved EF vs. Reduced EF
A preserved EF ratio (HFpEF) is found in 50%-60% of heart failure patients. Of those, 40%–60% also have A-Fib.
A reduced EF ratio (HFrEF) is found in 20%–25% of heart failure patients. If they also have A-Fib, the mortality rate is 25%–60% out to 5 years.
“If you look at the lectures [in this session], every one of them is Guideline changing This is the most important session of the whole [Symposium] meeting.”—Dr. Nassir Marrouche
Today, most medical attention is focused on these patients with reduced EF, in particular, an EF <35%. These are often treated by ace inhibitors, lasix, beta blockers, pacemakers, etc.
Dr Packer asserts that more research and treatment need to be focused on patients with Preserved EF (HFrEF).
Preserved EF and Catheter Ablation
Dr. Packer presented research findings about catheter ablation for patients with “preserved” ejection fraction (greater than 50%).
In the CABANA study, survival rates improved, patients were often free from A-Fib as well, and their quality of life was better compared to medical therapy [drug treatments]. This result may be limited to patients with preserved EF.
To read other presentations in this series, go to My Summary Reports Written for Atrial Fibrillation Patients.
