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ST-segment depression and left ventricular systolic function recovery post-atrial fibrillation ablation in heart

Masamichi Yano1, Yasuyuki Egami1, Shodai Kawanami1

  • 1Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.

ESC Heart Failure
|July 5, 2024
PubMed

Insights

ST-segment depression before catheter ablation (CA) in patients with persistent atrial fibrillation (PerAF) and heart failure with reduced ejection fraction (HFrEF) predicts poorer LVEF recovery and increased risk of major adverse cardiovascular events (MACE). This finding aids in patient risk stratification.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Catheter ablation (CA) for atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF) patients.
  • The prognostic value of ST-segment depression during AF rhythm before CA in this population is not well understood.

Purpose of the Study:

  • To investigate the association between ST-segment depression during AF rhythm before CA and LVEF recovery.
  • To evaluate the impact of ST-segment depression on clinical outcomes, including heart failure (HF) hospitalization and major adverse cardiovascular events (MACE), in patients with persistent AF (PerAF) and HFrEF.

Main Methods:

  • Analysis of 122 PerAF patients with LVEF < 50% from the ORAF registry who underwent initial CA.
  • Patients were categorized based on the presence or absence of ST-segment depression during AF rhythm before CA.
  • LVEF improvement (≥15%) at 1 year and the incidence of HF hospitalization/MACE were assessed.

Main Results:

  • A significantly lower percentage of patients with ST-segment depression showed LVEF improvement compared to those without (58.6% vs. 79.7%, P=0.012).
  • ST-segment depression was independently associated with reduced LVEF improvement (HR: 0.35; P=0.035).
  • Patients with ST-segment depression had a significantly higher risk of HF hospitalization (log rank P=0.022) and MACE (log rank P=0.002), and were independently associated with increased MACE risk (HR: 2.82; P=0.016).

Conclusions:

  • ST-segment depression before CA in PerAF patients with HFrEF is a significant predictor of impaired LVEF recovery.
  • The presence of ST-segment depression indicates a higher risk for future HF hospitalization and MACE.
  • This finding highlights the utility of ST-segment depression as a prognostic marker for guiding treatment decisions and risk stratification in these patients.
Abstract

Keywords:
Catheter ablationElectrocardiographyHeart failureLeft ventricular ejection fractionPersistent atrial fibrillationST‐segment depression

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