Left ventricular end-diastolic diameter (LVEDD) <53 mm may independently predict improvement of left ventricular ejection fraction (LVEF) in people with heart failure with reduced ejection fraction (HFrEF) and persistent atrial fibrillation (AF) after catheter ablation. This is according to research results published in Heart and Vessels.

Researchers sought to determine which factors might predict improvement of LVEF after catheter ablation in patients with HFrEF and persistent AF (>7 days). Study participants (n=401) underwent initial catheter ablation between 2014 and 2019.

Investigators analyzed consecutive patients with moderately or severely reduced LVEF (<50%), measured via transthoracic echocardiography (TTE) during AF rhythm, and who underwent follow-up TTE during sinus rhythm 6-months post-catheter ablation. They analyzed and categorized these patients into one of 2 groups:


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  • Improvement group, with an absolute improvement of LVEF ≥10% at follow-up TTE
  • Nonimprovement group, with an absolute improvement of LVEF <10% at follow-up TTE

The researchers included 81 patients in the final analysis (improvement: n=48; nonimprovement: n=33). At baseline, the presence of ischemic cardiomyopathy and mean LVEDD size was significantly lower in the improvement group (10.4% vs 36.4%, respectively, and 51.9±6.6 vs 58.9±5.8, respectively).

The study authors noted no significant differences in age, sex, body mass index, AF duration, hypertension, dyslipidemia, diabetes, chronic kidney disease, CHA2DS2-VASc score, or prescribed medications.

In addition, the investigators observed no significant differences regarding the ablation procedure, including pulmonary vein (PV) isolation, cavotricuspid isthmus block, superior vena cava isolation, left atrial posterior wall isolation, non-PV trigger ablation procedures, and procedure-related complications.

Researchers performed follow-up TTE at 293±90 and 305±113 days postoperatively, in the improvement and nonimprovement groups, respectively. Follow-up LVEDD was significantly smaller in the improvement group vs the nonimprovement group; this group also had lower rates of AF recurrence in between 3 and 6 months after catheter ablation (6M-LRAF) (14.6% vs 36.4%, respectively).

The researchers observed no significant differences in early recurrence of AF incidence or major events — including HF readmission and death — at 6 months in either group.

Results of a univariate analysis showed that the absence of ischemic cardiomyopathy, LVEDD <53 mm, and absence of 6M-LRAF were each associated with LVEF improvement. Receiver operating characteristic analysis results demonstrated a moderate accuracy in predicting LVEF improvement by LVEDD with a cutoff of 53 mm (sensitivity, 62.2%,; specificity, 86.2%; area under the curve, 0.762). Multivariate logistic regression analysis results showed that only LVEDD <53 mm was significantly and independently associated with LVEF improvement (odds ratio 2.58 [95% CI, 1.29-6.12]).

Study limitations include those inherent to retrospective, observational research and the underpowered size of the study, missing Holter electrocardiogram data from before the catheter ablation procedure, and the variable times at which the follow-up TTE was performed, potentially underestimating LVEF improvement.

“LVEDD <53 mm might be an independent predictor of improvement of LVEF after [catheter ablation] of persistent AF in patients with HFrEF,” the researchers concluded.

Reference

Ukita K, Egami Y, Nakamura H, et al. Predictors of improvement of left ventricular systolic function after catheter ablation of persistent atrial fibrillation in patients with heart failure with reduced ejection fraction. Heart Vessels. Published online March 21, 2021. doi:10.1007/s00380-021-01795-1