Key result
Smaller LVD linked to ~38% less freedom from AF post-ablation in patients with H2FPEF ≥6.
Why the study?
It was unclear whether paroxysmal AF patients with smaller left ventricles of normal height and weight benefit less from radiofrequency catheter ablation than those with larger left ventricles.
Does a smaller left ventricular diameter (<48 mm) reduce freedom from atrial fibrillation recurrence after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation and elevated H2FPEF scores?
Observational (n=133)
Single-blind
No
Does a smaller left ventricular diameter (<48 mm) reduce freedom from atrial fibrillation recurrence after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation and elevated H2FPEF scores?
In paroxysmal atrial fibrillation patients undergoing radiofrequency catheter ablation, having both a smaller left ventricle (LVD <48 mm) and a high H2FPEF score (≥6) is associated with a significantly lower ablation success rate (50% vs 80%, P = .037) compared to having a larger left ventricle.
Answers are grounded in this paper and cite their sources.
Smaller LV with high H2FPEF may flag higher AF recurrence risk post-ablation; leaves open whether dimension modifies outcomes in prospective trials.
The China-AF registry study linked small left ventricles (LVD < 42 mm) to poor outcomes in atrial fibrillation (AF) patients. Whether paroxysmal AF (PAF) patients with smaller left ventricles with normal height and weight (LVD larger than 42 mm and less than the average LVD) benefit less than those with larger LVD from the AF radiofrequency catheter ablation (RFCA) procedure was concerned. The median LVD was 48 mm, and the AF patients were divided into a larger LVD group (LVD >48 mm) and a smaller LVD group (LVD <49 mm). Clinical follow-up was also investigated. The H2FPEF score is recognized as a convenient method for screening patients with heart failure with preserved ejection fraction (HFpEF), which further reduced the ventricular filling. A total of 133 AF PAF were enrolled. 56 patients were enrolled in the smaller LVD group. Among patients with H2FPEF scores >5, 11/22 patients with smaller LVs and 20/25 patients with larger LVs were free of AF (50% vs 80%, respectively; P = .037). Among patients with smaller LVs, 11/22 patients with H2FPEF scores >6 and 27/34 patients with H2FPEF scores <6 were free of AF (50% vs 79.4%, respectively; P = .039). Among the 35 patients with PFO, 19/35 had an LVD >48 mm, Compared with patients who did not have PFO, those with LVD >48 mm had a younger average age (61.6 ± 9.6 vs 65.5 ± 8.3 years, P = .019). The success rate of PAF RFCA was affected in AF patients with H2FPEF scores ≥ 6 points and a smaller left ventricle than in those with a larger left ventricle. When the LVD was >48 mm, AF patients with PFO were younger than patients without PFO.
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Pang et al. (2025) conducted an observational in Paroxysmal atrial fibrillation (n=133). Smaller left ventricle (LVD < 48 mm) vs. Larger left ventricle (LVD ≥ 48 mm) was evaluated on Freedom from atrial fibrillation (p=.445). A smaller left ventricle (LVD < 48 mm) was associated with a significantly lower rate of freedom from atrial fibrillation after ablation compared to a larger left ventricle in patients with H2FPEF scores ≥ 6 (50% vs 80%).
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