One-Year Change in the H₂FPEF Score After Catheter Ablation of Atrial Fibrillation in Patients With a Normal Left Ventricular Systolic Function

Background: It is unclear whether atrial fibrillation (AF) catheter ablation (AFCA) improves the left ventricular (LV) diastolic function. We evaluated the 1-year change in the H₂FPEF score, which reflects the degree of LV diastolic function, after AFCA among patients with a normal LV systolic function. Methods and Results: We included 1,471 patients (30.7% female, median age 60 years, paroxysmal-type AF 68.6%) who had available H₂FPEF scores at baseline and at 1-year after AFCA to evaluate the 1-year change in the H₂FPEF score (ΔH₂FPEF score_[1−yr]) after AFCA. Baseline high H₂FPEF scores (≥6) were independently associated with the female sex, left atrium (LA) diameter, LV mass index, pericardial fat volume, and a low estimated glomerular filtration rate. One year after AFCA, decreased ΔH₂FPEF scores_[1−yr] were associated with baseline H₂FPEF scores of ≥6 [OR, 4.19 (95% CI, 2.88–6.11), p < 0.001], no diabetes [OR, 0.60 (95% CI, 0.37–0.98), p = 0.04], and lower pericardial fat volume [OR, 0.99 (95% CI, 0.99–1.00), p = 0.003]. Increased ΔH₂FPEF scores_[1−yr] were associated with a baseline H₂FPEF score of <6 [OR, 3.54 (95% CI, 2.08–6.04), p < 0.001] and sustained AF after a recurrence within 1 year [SustainAF_[1−yr]; OR, 1.89 (95% CI, 1.01–3.54), p = 0.048]. Throughout a 56-month median follow-up, an increased ΔH₂FPEF score_[1−yr] resulted in a poorer rhythm outcome of AFCA (at 1 year, log-rank p = 0.003; long-term, log-rank p = 0.010). Conclusions: AFCA appears to improve LV diastolic dysfunction. However, SustainAF_[1−yr] may contribute to worsening LV diastolic dysfunction, and it was shown by increased ΔH₂FPEF scores_[1−yr], which was independently associated with higher risk of AF recurrence rate after AFCA. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02138695.