Discordance between left atrial pressure and risk scores in assessment of heart failure with preserved ejection fraction in patients with atrial fibrillation undergoing catheter ablation

Abstract Background Identifying risk or probability of heart failure with preserved ejection fraction (HFpEF) in patients with atrial fibrillation (AF) is challenging. Purpose To assess the prevalence and factors associated with elevated LAP in AF patients undergoing catheter ablation and to evaluate the concordance between elevated LAP and HFpEF risk scores. Methods This study included 336 symptomatic AF patients (median age 65 years, 41% female) undergoing catheter ablation. Elevated LAP was defined as a mean LAP≥15 mmHg. High HFpEF probability was defined by H2FPEF≥6 and/or HFA-PEFF≥5. Results Elevated LAP was present in 37% (n=125) of patients, and factors associated with elevated LAP included higher body mass index (BMI; OR 1.21, 95% CI 1.11-1.31) and lower LA reservoir strain (OR 0.97, 95% CI 0.94-0.99). General anaesthesia and non-sinus rhythm were linked to higher LAP but not independently; AF type showed no effect. Among 204 eligible patients, 36% had a high HFpEF probability. Over 12 months, AF recurrence (26% vs 24%, p=0.775) and repeat ablations (11% vs 7.2%, p=0.230) were similar regardless of LAP status, but severe adverse events (death, life-threatening situations, hospitalizations or persistent disability) were more common in those with elevated LAP (6.7% vs. 1.7%, p=0.044). Conclusions Over one-third of ablation patients had elevated LAP. Poor agreement with HFpEF scores suggests limited utility in AF patients.