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Prognostic comparison of improved versus preserved left ventricular systolic function following atrial fibrillation

Miwa Kanai1, Kyoichiro Yazaki1, Koichiro Ejima2

  • 1Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.

Journal of Cardiology
|November 22, 2025
PubMed

Insights

Patients with improved systolic function after atrial fibrillation ablation have similar outcomes to those with preserved function. This finding suggests comparable prognoses for heart failure patients in both groups post-ablation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Heart failure (HF) patients with improved systolic function post-atrial fibrillation (AF) ablation may have better outcomes.
  • The prognostic value of this improvement compared to preserved systolic function is not well understood.

Purpose of the Study:

  • To compare the prognosis of HF patients with improved ejection fraction (EF) after AF ablation to those with preserved EF.
  • To evaluate the impact of AF ablation on systolic function in HF patients.

Main Methods:

  • 1538 patients undergoing AF ablation were analyzed; 272 with systolic dysfunction and 293 with high likelihood of HF with preserved EF (pEF).
  • Systolic dysfunction group was divided into improved EF (imp-EF, LVEF ≥50%) and non-improved EF (non-imp-EF, LVEF <50%) post-ablation.
  • Primary endpoint: composite of all-cause mortality and HF hospitalization. Propensity-score matching was used for comparison between imp-EF and pEF groups.

Main Results:

  • After matching, the imp-EF group showed a comparable risk of the primary endpoint to the pEF group (HR 0.40, p=0.09).
  • Atrial tachyarrhythmia (ATA) recurrence rates were similar between groups (HR 0.70, p=0.26).
  • In the imp-EF group, ATA recurrence predicted adverse events, while in the pEF group, E-wave velocity was the sole univariate predictor.

Conclusions:

  • Heart failure patients with improved EF post-AF ablation and those with preserved EF have similar long-term prognoses.
  • Atrial tachyarrhythmia recurrence is a significant factor for adverse events in patients with improved EF post-ablation.
Abstract

Keywords:
Atrial fibrillation ablationHeart failureLeft ventricular ejection fraction

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