Table 7.
Characteristics associated with LVEF recovery in response to AF catheter ablation in patients with impaired left ventricular systolic function
| Characteristics | Evidence |
|---|---|
| Lower NYHA class | Lower NYHA Class (I and II) at presentation is a predictor of significant LVEF recovery following AF ablation when compared with higher NYHA Class (III and IV) in patients with HFrEF256 |
| Non-ischemic etiology | Non-ischemic HF etiology is a significant predictor of LVEF improvement after AF ablation in patients with HFrEF256 |
| Persistent AF | Persistent AF is an independent predictor of LVEF improvement and left ventricular reverse remodelling after AF ablation in patients with impaired LVEF307–310 |
| Narrow QRS | Narrow QRS (≤120 ms) is an independent predictor of LVEF recovery after AF ablation in patients with impaired LVEF307,308 |
| Absence of CMR-detected atrial fibrosis | Extent of atrial fibrosis is inversely correlated to LVEF response following AF catheter ablation in patients with HFrEF311 |
| Absence of CMR-detected ventricular fibrosis | Absence of ventricular fibrosis is an independent predictor of LVEF normalization after AF catheter ablation in patients with non-ischemic cardiomyopathy and persistent AF250 |
| Post-cardioversion EF and NYHA improvement | Improvement in functional status and/or LVEF after cardioversion is indicative of underlying tachyarrhythmia-mediated cardiomyopathy and a favourable response to catheter ablation in HFrEF patients |
| Absence of severe atrial dilatation | Absence of severe atrial dilatation (LAVI ≤ 50 mL/m2) is an independent predictor of LVEF recovery after AF ablation in patients with impaired LVEF307,308 |
| AF preceding HF or simultaneous AF and HF diagnosis | Patients with simultaneous AF and HF diagnosis or AF history preceding HF diagnosis are more likely to present normalization of LVEF and resolution of HF symptoms following catheter ablation252,312 |
AF, atrial fibrillation; CMR, cardiovascular magnetic resonance; HF, heart failure; HFrEF, HF with reduced ejection fraction; LA, left atrial; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.