# HFA-PEFF score as a predictor of worsening heart failure after first-time catheter ablation for atrial fibrillation in patients with preclinical heart failure and preserved ejection fraction

## TL;DR

This study shows that the HFA-PEFF score can predict worsening heart failure after catheter ablation for atrial fibrillation in patients with early signs of heart failure and normal heart function.

## Contribution

The study demonstrates the HFA-PEFF score's predictive value for worsening heart failure after ablation in patients with preclinical heart failure.

## Key findings

- Patients with high HFA-PEFF scores had significantly higher rates of worsening heart failure after ablation.
- High HFA-PEFF score and AF recurrence were independent predictors of worsening heart failure.
- AF recurrence did not differ significantly between high and low HFpEF score groups.

## Abstract

Catheter ablation (CA) is a standard treatment for atrial fibrillation (AF); however, some patients experience worsening heart failure (WHF) afterward. The H2FPEF and HFA-PEFF scores are validated tools for HFpEF risk stratification, but their predictive value for WHF after CA in patients with preclinical heart failure (HF) remains unclear.

This retrospective, single-center observational study included 257 AF patients with preserved left ventricular ejection fraction (LVEF) ≥50% and no history or symptoms of HF who underwent first-time CA between February 2017 and September 2022. Patients were classified as high HFpEF score group if they had H2FPEF score ≥6 or HFA-PEFF score ≥5. The primary endpoint was WHF: HF hospitalization, initiation of oral diuretics, or intravenous administration of diuretics.

Among 257 patients, 54 (21.01%) were classified as high HFpEF score group. WHF incidence was significantly higher in the high HFpEF score group than in the low HFpEF score group (log-rank p < 0.001), while AF recurrence did not differ significantly (log-rank p = 0.546). In Firth's penalized logistic regression analysis, high HFA-PEFF score (HR 6.52, 95% CI 1.54–23.21, p = 0.014) and AF recurrence (HR 8.18, 95% CI 1.80–77.60, p = 0.005) appeared to be potential independent predictors of WHF.

In this exploratory analysis, the HFA-PEFF score potentially represent an independent predictor of WHF after CA in AF patients with preclinical HF and preserved LVEF.