The Safety and Efficacy of Pulsed Field Ablation for Patients With Persistent Atrial Fibrillation Comorbid With HFpEF.

Prior treatment

• Patients who had used class I or class III antiarrhythmic drugs, but the use of the above drugs for less than 7 days to convert atrial fibrillation was allowed;
• Previous left atrial ablation or surgery (including left atrial appendage occlusion);
• Previous pulmonary vein stenting;
• Previous pulmonary vein stenosis;
• Any cardiac surgery, myocardial infarction, percutaneous coronary intervention (PCI)/percutaneous transluminal coronary angioplasty (PTCA) or coronary artery stenting within three months before signing the informed consent;
• Patients with known drug or alcohol addiction;

Other illness

• Presence of any heart valve prosthesis;
• Unstable angina or severe coronary artery stenosis;
• Primary pulmonary hypertension;
• Rheumatic heart disease;
• Any disease that prohibits long-term anticoagulation;
• Active systemic infection;
• Patients with malignant tumors;

Other

• Patients with persistent atrial fibrillation lasting for more than 3 years;
• Left atrial diameter \> 50 mm;
• Thrombocytosis, thrombocytopenia;
• Atrial fibrillation caused by reversible causes, such as hyperthyroidism;
• Women known to be pregnant or breastfeeding;
• Life expectancy of less than one year;
• Patients with intracardiac thrombus;
• Patients who are unwilling or unable to fully comply with the study protocol and complete follow-up;
• Participating in other clinical trials that may interfere with the results.

• Age 18-80 years;
• Patients with persistent atrial fibrillation;
• According to the 2021 European Society of Cardiology (ESC) guidelines for heart failure, heart failure with preserved ejection fraction (HFpEF) is defined as patients with preserved or slightly reduced left ventricular ejection fraction (LVEF) but with diastolic dysfunction. The diagnostic criteria for HFpEF include: symptoms and signs of heart failure; LVEF≥50%; and objective evidence of cardiac structural and functional abnormalities consistent with left ventricular diastolic dysfunction or increased left ventricular filling pressure. These can be verified by imaging examinations such as echocardiography and biomarkers such as B-type natriuretic peptide or NT-proBNP. The thresholds for B-type natriuretic peptide or NT-proBNP are: BNP≥35 pg/mL or NT-proBNP ≥125 pg/mL for patients with sinus rhythm; BNP≥105 pg/mL or NT-proBNP ≥365 pg/mL for patients with atrial fibrillation.
• Agree to participate in this study and sign the informed consent form. Have clinical compliance to complete the postoperative follow-up required by the protocol.