Usefulness of Preprocedural Left Ventricular End-Systolic Volume Index and Early Diastolic Mitral Annular Velocity in Predicting Improvement in Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Impaired Left Ventricular Systolic Function

Abstract

Catheter ablation of atrial fibrillation (AF) is known to facilitate reverse remodeling of the left ventricle. However, factors that can improve the left ventricular (LV) systolic function remain elusive. In this study, we investigated factors related to LV ejection fraction (LVEF) improvement following AF ablation in patients with systolic dysfunction. A total of 140 patients with impaired LVEF (<50%) who underwent AF ablation were retrospectively evaluated. The primary outcome was LVEF improvement. A total of 68, 9, and 15 patients achieved LVEF improvement at 3, 6, and 12 months after AF ablation, respectively. Five patients achieved late LVEF improvement. The overall LVEF improvement rate was 69%. In the receiver operating characteristic curve analysis, the LV end-systolic volume (LVESVI) and early diastolic mitral annular velocity (e') had larger areas under the curve (0.79 and 0.75, respectively) than other echocardiographic parameters, and the most optimal cutoff values of LVESVI and e' were 49.8 ml/m2 and 5.4 cm/s, respectively. Moreover, preprocedural LVESVI ≤49.8 ml/m2 and e' ≥5.4 independently predicted the outcome after adjusting for confounders (hazard ratio 1.74; 95% confidence interval 1.06 to 2.95; p = 0.03; hazard ratio, 1.99; 95% confidence interval 1.13 to 3.64; p = 0.01). LVEF improvement was achieved in 69% of patients who underwent AF ablation, including 4% with late improvement. Lower LVESVI and higher e' could independently predict LVEF improvement.