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.

QRS duration >120ms2
Known aetiology of heart failure2
Paroxysmal AF1
Severe left atrial dilatation >50ml/m21

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. 

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


  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.