Abstract
Aims: Catheter ablation should be considered in patients with atrial fibrillation (AF) and with heart failure (HF) with reduced ejection fraction (EF; HFrEF) to improve survival and reduce heart failure hospitalization. Careful patient selection for AF ablation is key to achieving similar outcome benefits. However, limited data exist regarding predictors of recovered ejection fraction. We aimed to evaluate the predictors of recovered ejection fraction in consecutive patients with HF undergoing AF ablation.Methods and Results: A total of 156 patients [67.3% men, median age 63 (11)] with AF and HF underwent initial catheter ablation between September 2017 and October 2019 in the First Affiliated Hospital of Dalian Medical University. Overall, the percentage of recovered ejection fractions was 72.3%. Recovered EFs were associated with a 39% reduction in all-cause hospitalization compared to non-recovered EFs at the 1-year follow-up [23.8 vs. 62.8 (odds ratio) OR 2.09 (1.40–3.12), P < 0.001]. Univariate analysis for recovered EFs showed that diabetes (P = 0.083), prevalent HF (P = 0.014), prevalent AF (P = 0.051), LVEF (P = 0.022), and E/E′ (P = 0.001) were associated with EF improvement. Multivariate analysis showed that the only independent predictor of EF recovery was E/E′ [OR 1.13 (1.03–1.24); P = 0.011]. A receiver operating characteristic analysis determined that the suitable cut-off value for E/E′ was 15 (sensitivity 38.7%, specificity 89.2%, the area under curve 0.704).Conclusions: Ejection fraction (EF) recovery occurred in 72.3% of patients, associated with a 39% reduction in all-cause hospitalization compared to the non-recovered EFs in our cohort. The only independent predictor of recovered EF was E/E′ < 15 in our series.
Highlights
The atrial fibrillation epidemic has been closely linked to a concomitant rise in heart failure (HF) morbidity and mortality [1]
The mean left ventricular ejection fraction (LVEF) was improved from 38% to 57% in the recovered group (P < 0.001), and the mean LVEF was not significant in the nonrecovered group
After the 1-year follow-up, 25 (24%) hospitalizations occurred in the recovered group, and 27 (63%) hospitalizations occurred in the non-recovered group
Summary
The atrial fibrillation epidemic has been closely linked to a concomitant rise in heart failure (HF) morbidity and mortality [1]. Recent randomized controlled trials (RCTs) reported clinical improvements in mortality, HF hospitalizations, left ventricular ejection fraction (LVEF), and quality of life in patients with HFrEF (HF with reduced ejection fraction) who had AF ablation [3,4,5]. Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) revealed a benefit of mortality and HF hospitalizations in AF ablation patients. The AF Management in Congestive HF with Ablation (AMICA) trial was a large RCT to compare the absolute increase in LVEF from baseline at 1 year between ablation and the best medical therapy in patients with persistent AF and HF [9]. These controversial results raised the issue that stratification for AF in HF patients remains challenging in clinical practice. Patients with HF and AF benefit the most from catheter ablation should be fully evaluated
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