Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure : a prediction model
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
AIMS: Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort.
METHODS AND RESULTS: A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001).
CONCLUSION: In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.
| Errataetall: |
CommentIn: Eur Heart J. 2023 Sep 14;44(35):3336-3338. - PMID 37387669 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:44 |
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| Enthalten in: |
European heart journal - 44(2023), 35 vom: 14. Sept., Seite 3327-3335 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bergonti, Marco [VerfasserIn] |
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| Links: |
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| Themen: |
AF ablation |
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| Anmerkungen: |
Date Completed 15.09.2023 Date Revised 18.09.2023 published: Print CommentIn: Eur Heart J. 2023 Sep 14;44(35):3336-3338. - PMID 37387669 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehad428 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358889421 |
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| 245 | 1 | 0 | |a Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure |b a prediction model |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 18.09.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Eur Heart J. 2023 Sep 14;44(35):3336-3338. - PMID 37387669 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a AIMS: Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort | ||
| 520 | |a METHODS AND RESULTS: A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001) | ||
| 520 | |a CONCLUSION: In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a AF ablation | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Pulmonary vein isolation | |
| 650 | 4 | |a Recovery | |
| 650 | 4 | |a Reduced ejection fraction | |
| 650 | 4 | |a Score | |
| 700 | 1 | |a Ascione, Ciro |e verfasserin |4 aut | |
| 700 | 1 | |a Marcon, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Pambrun, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Della Rocca, Domenico G |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrero, Teba Gonzalez |e verfasserin |4 aut | |
| 700 | 1 | |a Pannone, Luigi |e verfasserin |4 aut | |
| 700 | 1 | |a Kühne, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Compagnucci, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Bonomi, Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Gevaert, Andreas B |e verfasserin |4 aut | |
| 700 | 1 | |a Anselmino, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Casella, Michela |e verfasserin |4 aut | |
| 700 | 1 | |a Krisai, Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Tondo, Claudio |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez-Mañero, Moises |e verfasserin |4 aut | |
| 700 | 1 | |a Derval, Nicolas |e verfasserin |4 aut | |
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| 700 | 1 | |a Jaïs, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Sarkozy, Andrea |e verfasserin |4 aut | |
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