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

Catheter ablation for persistent atrial fibrillation with left ventricular systolic dysfunction: Who is the best candidate?

“…Recent consensus 14 illustrated that in regard to LVEF normalization and sinus rhythm maintenance, multiple patient variables should be taken into consideration when deciding for catheter ablation, including suspected AF‐mediated cardiomyopathy, NYHA class I/II, no LV scar on LGE‐MRI, none/mild atrial fibrosis, paroxysmal AF or early PerAF. Echocardiographic parameters, such as high early diastolic mitral annular velocity, a marker reflecting the LV diastolic function, was also reported as independent predictor for LVEF improvement 15 . But for PerAF in HF, AF duration is often unclear and detected following the diagnosis of HF.…”

Catheter Ablation for Atrial Fibrillation Targeting Incremental Left Ventricular Ejection Fraction ― Reply ―

“… 3 We previously investigated the predictors of an improvement in LVEF (defined as an improvement to an LVEF >50% or an absolute increase of 20%) after AF ablation in patients with an impaired systolic function. 4 Only 6 patients had ischemic heart disease, and 4 of these patients experienced an improvement in LVEF (P=1.00); this study had too small a sample size to assure statistical confidence. Having said that, we speculated that an ischemic etiology would principally have a negative effect on the improvement in LVEF, but that this would depend on the myocardial scar volume, as mentioned by Chapman and Imamura.…”

“… 5 In a previous study, we also elucidated that ATA recurrence has a significant effect on improvements in LVEF. 4 In our more recent study, 6 sinus rhythm was maintained after multiple procedures in 73% of all patients off anti-arrhythmic drugs 1 year after the index procedure. This strongly affected the absolute increase in LVEF (mean [±s.d.]…”

“…We also reported that the pre-early diastolic mitral annular velocity (e′) and pre-left ventricular end-systolic volume index (LVESVI) have substantial relationships with the improvement in LVEF. 4 Among the echocardiographic parameters, e′ and LVESVI had a moderate predictive value for an improvement in LVEF (area under the curve 0.753 and 0.788, respectively). Furthermore, a high e′ and low LVESVI could independently predict an improvement in LVEF after adjustment for relevant covariates, including the presence of structural heart disease, left atrial volume index, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, and ATA recurrence.…”

“…In addition, ATA recurrences significantly predicted a poor prognosis in the univariate analysis (hazard ratio 3.62; 95% confidence interval 1.36–11.29; P=0.01). 4 In addition, a previous study showed a significant reduction in the AF burden after AF ablation even if AF recurred. 7 We demonstrated that 27% of the subjects with an improvement in LVEF after AF ablation had an ATA recurrence during the follow-up period, suggesting that the decrease in the AF burden possibly contributed to the improvement in LVEF.…”