Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: The Fibrosis-HF Study

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  • Bettina Kirstein, Technische Universität Dresden
  • ,
  • Sebastian Neudeck, Technische Universität Dresden
  • ,
  • Thomas Gaspar, Technische Universität Dresden
  • ,
  • Judith Piorkowski, Technische Universität Dresden
  • ,
  • Simon Wechselberger, Technische Universität Dresden
  • ,
  • Mads Brix Kronborg
  • Angela Zedda, Technische Universität Dresden
  • ,
  • Anastasia Hankel, Steinbeis Research Institute ‘Rhythm and Heart’
  • ,
  • Ali El-Armouche, Technische Universität Dresden
  • ,
  • Jakub Tomala, Technische Universität Dresden
  • ,
  • Thomas Schmidt, Department of Electrophysiology, Technische Universität Dresden
  • ,
  • Julia Mayer, Technische Universität Dresden
  • ,
  • Michael Wagner, Department of Electrophysiology, Technische Universität Dresden
  • ,
  • Stefan Ulbrich, Technische Universität Dresden
  • ,
  • Liying Pu, Technische Universität Dresden
  • ,
  • Utz Richter, Technische Universität Dresden
  • ,
  • Yan Huo, Technische Universität Dresden
  • ,
  • Christopher Piorkowski, Technische Universität Dresden

Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation. Methods and In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] unresults dergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF >_10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P < 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P < 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P < 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P < 0.001). Conclusion Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.

Original languageEnglish
Pages (from-to)1812-1821
Number of pages10
Publication statusPublished - 1 Dec 2020

Bibliographical note

Publisher Copyright:
© The Author(s) 2020.

Copyright 2021 Elsevier B.V., All rights reserved.

    Research areas

  • Ablation, Atrial fibrillation, Heart failure, Left atrial fibrosis, Left ventricular ejection fraction

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