CONGRESS ABSTRACT

Background Catheter ablation (CA) of atrial fibrillation (AF) is recognised as an important strategy to improve systolic disfunction and to reduce mortality in selected patients with heart failure (HF). Nowadays, pulsed-field-ablation (PFA) represents a revolutionary energy source mostly used to perform fast and effective CA of AF. Remote monitoring (RM) systems of implantable electronic devices (CIEDs) play an important role during follow-up, as they can help physicians in detecting recurrences of AF and early decompensation phases in HF. Methods We conducted a retrospective exploratory analysis about trend modification of physiological parameters related to HF detected by RM systems during the 60 days before and after CA of AF performed with PFA. The selected parameters included: intrathoracic impedance, mean and nocturnal heart rate (MHR and NHR), and respiratory rate (RR). All consecutive patients treated with CA of AF with PFA at our centre and having CIEDs in RM were screened for data availability and potential inclusion in the study. Results At the end of the screening process, two patients aged 61 and 58 years respectively were identified, both implanted with a single chamber automated implantable cardioverter defibrillator (ICD). The first one was implanted for primary prevention, due to severe ischemic left ventricular dysfunction; the second one for secondary prevention after an out-of-hospital cardiac arrest with shockable rhythm in a non-dilated left ventricular cardiomyopathy. Both patients suffered persistent AF, present at the time of ablation, and underwent CA with PFA. Our analyses showed a significant improvement of intrathoracic impedance, together with a reduction of MHR, NHR, and RR in both patients during the 60 days after CA (Table 1 and Figure 1). Improvement of intrathoracic impedance, however, was only seen after its transitory reduction during the first 7 days after CA (P=0.028 and P=0.016 for patients 1 and 2, respectively). Heart rate reduction occurred early in time, as it was seen right after the first week from CA, while intrathoracic impedance and RR changes were later detected in the follow-up period. Conclusions RM could represent a strong weapon to evaluate the pathophysiological effect of CA of AF in patients with CIEDs. These data could represent a starting point for further studies on a larger population to provide information on how CA can improve life expectancy and interfere with the pathophysiology of HF.