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).

Conclusions: 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.