CAMERA-MRI score to predict left ventricular ejection fraction normalization post-ablation for primary atrial...

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Imaging

Background:

• Atrial fibrillation (AF)-mediated cardiomyopathy is diagnosed retrospectively when left ventricular ejection fraction (LVEF) normalizes post-catheter ablation.
• Predicting which patients will achieve LVEF normalization prospectively remains a clinical challenge.

Purpose of the Study:

• To identify predictors of LVEF normalization in patients with AF-mediated cardiomyopathy undergoing catheter ablation.
• To develop a practical score for predicting LVEF recovery.

Main Methods:

• Pooled analysis of CAMERA-MRI and CAMERA-MRI II multicenter randomized trials using serial cardiac magnetic resonance (CMR).
• Multivariable logistic regression assessed predictors of LVEF normalization.
• Internal validation using bootstrap resampling and 5-fold cross-validation.

Main Results:

• 113 patients with baseline LVEF of 31.0±8.7% were included; 63.7% achieved LVEF normalization.
• Independent predictors for normalization were: normal indexed LV end-diastolic volume (OR=3.20), absence of alternate aetiology (OR=4.31), and absence of late gadolinium enhancement (OR=2.53).
• A predictive score demonstrated increasing likelihood of normalization from 12% (0/3 predictors) to 88% (3/3 predictors).

Conclusions:

• Absence of late gadolinium enhancement, normal LV volumes, and absence of alternative aetiology identify patients with AF-induced cardiomyopathy most likely to normalize LVEF post-ablation.
• These factors can guide clinical decision-making for catheter ablation in AF-cardiomyopathy.