Abstract
Background In patients with atrial fibrillation (AF) and heart failure (HF), pulmonary vein isolation (PVI) was shown to be superior to pharmacological therapy. However, only a variable percentage of patients improves and how these patients should be identified remains uncertain. Objective to investigate the predictors of left ventricular (LV) systolic function recovery after PVI and to develop a prediction model for individualised assessment. Methods We conducted an observational, retrospective, single centre study of consecutive patients with AF and HF undergoing PVI. Patients were divided into Responder vs. Non-Responder (NR) according to the ‘Universal definition and classification of HF’. Clinical predictors were evaluated by multivariate logistic regression analysis and cross-validation technique. Independent predictors were used to build an internally validated prediction model. Results One-hundred-and-eleven patients (61 ± 10 years, 61% male) were included and followed for 34 (20–58) months. Patients in the Responder group had significantly shorter QRS duration (97 vs. 137 ms, p < 0.001) and less dilated left atria (38 vs. 50 mL/m2, p < 0.001). Persistent AF and concomitant AF-HF diagnoses were more frequent among Responders. AF/AFL/AT recurrence was 35% in the Responder vs. 49% in the Non-Responder group (p = 0.2). Time to recovery in the Responder-Group was 4.8 (0.6–10.4) months. The absence of known underlying Cardiomyopathy (CMP), persistent AF, left atrial volume index (LAVI) < 50ml/m2, and QRS <120msec were significant predictors of systolic function recovery and were included in the Antwerp Score. Patients with Antwerp Score ≤1 had a 90% likelihood of Response compared to 5% in patients with ≥3 points. Conclusions HF Patients with systolic LV function recovery after PVI have less frequently wide QRS complex and known underlying CMP, less dilated left atria, and more frequently persistent AF. A new score system based on four clinical parameters (QRS duration, LA volume, persistent AF and known underlying CMP) can accurately predict LV function recovery after PVI.
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