Low left atrial voltage predicts lack of improvement in left ventricular systolic function post atrial fibrillation ablation in patients with systolic heart failure.

Catheter Ablation of Atrial Fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) is associated with decreased all-cause mortality, and improvement in left ventricular ejection fraction (EF). Predictors of EF improvement post-AF ablation is not known. In this study we conducted a retrospective review of patients who underwent catheter ablation for AF within last 6 years. 82 Patients undergoing catheter ablation for paroxysmal or persistent AF with EF <45% were included in the study, 18 patients were lost to follow up and therefore were excluded. The patients were divided into 2 groups based on presence or absence of 5% improvement in LVEF post CA, compared to LVEF obtained prior to CA. Mean improvement in EF after ablation was 17±11.8%. As compared to baseline, EF improved by at least 5% in 80% (n=51) of the patients who underwent ablation. Patients with improved EF had significantly higher average total voltage in the LA compared to patients who had no improvement in EF (1.70±1.16 vs 1.00±0.82, p=0.02*). In the multivariable model, after adjusting for other risk factors, LA average total voltage was significantly higher in the group with improved EF (p=0.04*).