Left ventricular ejection fraction response after atrial fibrillation ablation: Clinical predictors and development...

Catheter ablation for atrial fibrillation (AF) in left ventricular systolic dysfunction (LVSD) improves outcomes, yet left ventricular ejection fraction (LVEF) response is difficult to prospectively predict.

This study aimed to identify preprocedural predictors of LVEF response after AF ablation in patients with LVSD and develop a pragmatic score to stratify patients.

This multicenter cohort study included patients with AF and an LVEF of <50% undergoing index ablation. The primary endpoint was responder status defined as ≥10% increase in LVEF or improvement to ≥50% on follow-up echocardiography after the final ablation. Multivariable logistic regression modeling, stratified by follow-up rhythm, was used to identify predictors and derive a simplified scoring tool.

Among 366 patients (aged 64.4 ± 10.6 years; 82% male), 70.8% were left ventricular responders at follow-up. Predictors of nonresponse in the sinus rhythm subgroup included heart failure etiology, QRS duration of >105 ms, paroxysmal AF, and type 2 diabetes. These were incorporated into the PACED score, which stratified response (score <2, 87% probability of response; score ≥3, 71% of nonresponse) with good discrimination (c-statistic 0.83; 95% confidence interval 0.77-0.89). In the largest contemporary multicenter cardiac magnetic resonance subcohort, late gadolinium enhancement was more frequent among nonresponders (84.6% vs 53.6%; P < .001). Guideline-directed medical therapy at baseline was not independently associated with recovery.

LVEF response post-AF ablation in patients with LVSD can be accurately predicted precatheter ablation with a bedside score. Left ventricular response depends primarily on substrate and conduction characteristics rather than pharmacotherapy in a guideline-directed medical therapy-optimized cohort. Late gadolinium enhancement on cardiac magnetic resonance is associated with an increased chance of being a nonresponder to ablation.