Among patients with atrial fibrillation and LV dysfunction undergoing pulmonary vein isolation, 53% achieved LVEF recovery, with late gadolinium enhancement strongly predicting persistent dysfunction.
Cohort (n=172)
Does the presence of late gadolinium enhancement predict nonrecovery of left ventricular systolic function in patients with atrial fibrillation and LV dysfunction undergoing pulmonary vein isolation?
The absence of late gadolinium enhancement on CMR and freedom from AF recurrence are strong predictors of LVEF recovery after pulmonary vein isolation in patients with AF and LV dysfunction.
BACKGROUND: The factors that predict recovery of left ventricular (LV) systolic dysfunction among patients with atrial fibrillation (AF) are not completely understood. Late gadolinium enhancement (LGE) of the LV has been reported among patients with AF, and we aimed to test whether the presence LGE was associated with subsequent recovery of LV systolic function among patients with AF and LV dysfunction. METHODS AND RESULTS: From a registry of 720 consecutive patients undergoing a cardiac magnetic resonance study prior to pulmonary vein isolation (PVI), patients with LV systolic dysfunction (ejection fraction EF 50%; a secondary outcome was a combined outcome of subsequent heart failure (HF), admission, and death. Of 720 patients, 172 (24%) had an LVEF of <50% prior to PVI. The mean LVEF pre-PVI was 41±6% (median 43%, range 20% to 49%). Forty-three patients (25%) had LGE (25 58% ischemic), and the extent of LGE was 7.5±4% (2% to 19%). During follow-up (mean 42 months), 91 patients (53%) had recovery of LVEF, 68 (40%) had early recurrence of AF, 65 (38%) had late AF, 18 (5%) were admitted for HF, and 23 died (13%). Factors associated with nonrecovery of LVEF were older age, history of myocardial infarction, early AF recurrence, late AF recurrence, and LGE. In a multivariable model, the presence of LGE and any recurrence of AF had the strongest association with persistence of LV dysfunction. Additionally, all patients without recurrence of AF and LGE had normalization of LVEF, and recovery of LVEF was associated with reduced HF admissions and death. CONCLUSIONS: In patients with AF and LV dysfunction undergoing PVI, the absence of LGE and AF recurrence are predictors of LVEF recovery and LVEF recovery in AF with associated reduction in subsequent death and heart failure.
Addison et al. (Thu,) conducted a cohort in Atrial fibrillation and left ventricular systolic dysfunction (n=172). Late gadolinium enhancement (LGE) vs. Absence of LGE was evaluated on Recovery of LVEF defined as an EF >50%. Among patients with atrial fibrillation and LV dysfunction undergoing pulmonary vein isolation, 53% achieved LVEF recovery, with late gadolinium enhancement strongly predicting persistent dysfunction.