A new prediction model for left ventricular systolic function recovery after catheter ablation of atrial fibrillation in patients with heart failure and reduced ejection fraction, The ANTWOORD Study

• Published in: Europace (London, England) Vol. 24; no. Supplement_1
• Main Authors: Bergonti, M, Spera, F, Tijskens, M, Bonomi, A, Saenen, J, Huybrechts, W, Miljoen, H, Wittock, A, Casella, M, Tondo, C, Heidbuchel, H, Sarkozy, A
• Format: Journal Article
• Language: English
• Published: 19.05.2022
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac053.185

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF), pulmonary vein isolation (PVI) improves left ventricular ejection fraction (LVEF), along with prognosis, in a variable percentage of patients. Aim To investigate the predictors of LVEF recovery after PVI and to develop a prediction model for individualized assessment. Methods We conducted an observational, retrospective, single-center study on 111 consecutive patients with AF and HFrEF undergoing PVI. Patients were divided into Responder vs. Non-Responder according to the "Universal definition of HF". Clinical predictors were evaluated by multivariate logistic regression analysis and cross-validation technique. Independent predictors were used to build an internally validated prediction model. Results Responders (54%) had significantly shorter QRS duration and less dilated left atria. Persistent AF and absence of a known etiology more frequent among Responders. AF recurrence was non-significantly different between the two groups (p=0.2), although clinical AF burden was lower in Responders, after PVI (p<0.001). Absence of known etiology, presence of persistent AF, left atrial volume index<50ml/m2, and QRS<120msec were independent predictors of LVEF recovery and composed the "Antwerp Score". Patients with Antwerp Score ≤1 had 90% likelihood of LVEF recovery, compared to 5% in patients with 3-6. Conclusions Patients with wide QRS complex, known HF etiology, dilated left atria, and paroxysmal AF were less likely to recover LVEF after PVI. A new score system based on the above-mentioned parameters adequately predict LV function recovery after PVI. These results warrant confirmation and prospective validation.