Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study

Abstract

Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation. Methods and results In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P < 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P < 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P < 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P < 0.001). Conclusion Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.

Selvester QRS score predicts improvement of LVEF in atrial fibrillation patients with systolic heart failure

“…Previous studies have demonstrated that AF patients with LVSD could benefit from catheter ablation more than from medical treatment; a significant increase in LVEF after catheter ablation has been reported with a range between 8% and 20%. [9][10][11][12][13] In this study, an increase of LVEF at 12-month follow-up after catheter ablation was 21%, almost similar to, or even higher than the values in the previous studies. [8][9][10][11][12] The present study included patients with more severe systolic heart failure (LVEF ≤40%) than in previous studies (45% ≤ LVEF ≤50%).…”

“…[9][10][11][12][13] In this study, an increase of LVEF at 12-month follow-up after catheter ablation was 21%, almost similar to, or even higher than the values in the previous studies. [8][9][10][11][12] The present study included patients with more severe systolic heart failure (LVEF ≤40%) than in previous studies (45% ≤ LVEF ≤50%). with LVSD were negatively correlated with improvement of LVEF after catheter ablation.…”

“…Univariate and multivariate analyses were performed to find significant predictors for LVEF normalization. Previous studies have reported that LV diastolic function and LA remodeling were associated with LVEF improvement in AF patients undergoing catheter ablation 9,10 . We therefore included E/e’ and LAD as significant covariates in this study.…”

“…Previous studies have reported that LV diastolic function and LA remodeling were associated with LVEF improvement in AF patients undergoing catheter ablation. 9,10 We therefore included E/e' and LAD as significant covariates in this study. The analyses demonstrated that S-QRS score was an independent predictor of LVEF normalization (Table 3).…”

Low-Voltage Area at the Anterior Wall of the Left Atrium Is Associated With Thromboembolism in Atrial Fibrillation Patients With a Low CHA2DS2-VA Score

“…After observing the left atrial geometry, pulmonary vein isolation (PVI) was performed under conscious sedation using intravenous fentanyl and via transseptal access to the left atrium. Assessment of LA surface area and LVA followed a clinical routine and were performed as described previously ( 15 , 16 ). A sequential high-density 3D bipolar voltage map (at least 300 points per patient) was constructed in all patients during sinus rhythm, guided by a 3D electroanatomic mapping system (CARTO3, Biosense Webster, or Ensite velocity, Abbott) using a circular mapping catheter (Lasso, 4 mm interelectrode spacing, Biosense Webster or Advisor FL, 3 mm, interelectrode spacing, Abbott).…”