Predicting left ventricular ejection fraction improvement after atrial fibrillation ablation

By Dr Megha Agarwal
Edited by Dr Saadia Aslam

Atrial fibrillation (AF) and heart failure (HF) often co-exist and in combination are associated with increased mortality. ESC guidelines¹ suggest AF ablation for patients with a high probability of tachycardia induced cardiomyopathy. However, there is no objective way of identifying these high-risk patients or estimating the success post procedure.

The ANTWOORD investigators² presented the ANTWERP score to risk stratify HF patients who may benefit from a transcatheter AF ablation, at EHRA late breaking science session.

Criterion	Score
QRS duration >120ms	2
Known aetiology of heart failure	2
Paroxysmal AF	1
Severe left atrial dilatation >50ml/m2	1
TOTAL POSSIBLE SCORE	6

A low score is associated with increased likelihood of left ventricular ejection fraction (LVEF) improvement. In a study of 605 patients (mean age 61 years, 76% male), 70% (n=427) of patients showed improvement in LVEF, 12 months post ablation. Those with scores of 0 or 1 had over 90% chance of LVEF improvement, compared with only 17% for those with scores of 5-6. However, AF duration is not a determining factor in the ANTWERP score, but persistent vs paroxysmal AF increases the probability of LVEF improvement. Further sub-group analysis will need to be performed to determine the impact of age and sex.

Adopting this score into clinical practice may aid clinical decision-making regarding referrals for AF catheter ablation. The full results from this study are anticipated. 

Read more at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/novel-score-predicts-heart-failure-improvement-after-atrial-fibrillation-ablatio

This study was presented at a late breaking science session in EHRA 2023; the full paper is yet to be published.

References:

1. Hindricks G, Potpara T, Nikolaos Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498.
2. Bergonti M, Spera F, Tijskens M, et al. A new prediction model for left ventricular systolic function recovery after catheter ablation of atrial fibrillation in patients with heart failure: The ANTWOORD Study. Int J Cardiol. 2022;358:45–50.