Predictors of Improvement in Left Ventricular Systolic Dysfunction in Patients with Atrial Fibrillation Undergoing Catheter Ablation: Systematic Review.

IF 3.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Arrhythmia & Electrophysiology Review Pub Date : 2025-01-30 eCollection Date: 2025-01-01 DOI:10.15420/aer.2024.24
Nikhil Ahluwalia, Ahmed Hussain, Rui Providencia, Richard J Schilling
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引用次数: 0

Abstract

Background: Left ventricular systolic dysfunction (LVSD) can improve after catheter ablation (CA) in many patients with AF. However, prospective prediction of response can be challenging. The aim of this study was, therefore, to perform a systematic literature review of features associated with improvement in left ventricular ejection fraction (LVEF) in patients with AF and LVSD undergoing first CA.

Method: Systematic search of Ovid MEDLINE, Embase and Cochrane Library databases up to 24 January 2024, for studies involving adult patients with LVSD receiving treatment for AF. The focus was on research articles and clinical trials reporting features associated with changes in LVEF following CA. The review followed PRISMA guidelines.

Results: A total of 789 unique articles were reviewed and 20 were included in the systematic review. Sixty-nine per cent (range, 54-79%) of included patients met the criteria for responder status, which were based on LVEF improvement (usually an increase in LVEF >10% or to >50% at follow-up). Baseline surrogates of myocardial fibrosis on MRI (R2=-0.67), electroanatomical mapping (R2=-0.93) and biochemical surrogates have shown the strongest association with LVEF change. Left atrium and LV chamber size, diastolic dysfunction ECGbased parameters and a known heart failure aetiology have shown prognostic value independently and in combination.

Discussion: Imaging, clinical and ECG-based surrogates of LV fibrosis may be pre-CA markers of LVEF improvement in patients with AF and LVSD. However, the confounding effect of procedural outcomes should be considered. A composite risk stratification tool would have clinical utility in risk stratification and patient selection; however, prospective studies are needed.

房颤患者行导管消融后左室收缩功能障碍改善的预测因素:系统综述。
背景:许多房颤患者在导管消融(CA)后左心室收缩功能障碍(LVSD)可以改善。然而,对反应的前瞻性预测可能具有挑战性。因此,本研究的目的是对首次行ca的房颤和LVSD患者左室射血分数(LVEF)改善相关特征进行系统的文献综述。系统检索截至2024年1月24日的Ovid MEDLINE、Embase和Cochrane Library数据库,检索涉及房颤治疗的成年LVSD患者的研究。重点是报道CA后LVEF变化相关特征的研究文章和临床试验。结果:共纳入文献789篇,系统评价纳入文献20篇。纳入的患者中有69%(范围,54-79%)符合应答状态的标准,这是基于LVEF改善(通常在随访时LVEF增加10%或增加50%)。MRI心肌纤维化基线替代指标(R2=-0.67)、电解剖定位指标(R2=-0.93)和生化替代指标与LVEF变化的相关性最强。左心房和左室大小,舒张功能障碍心电图参数和已知的心力衰竭病因单独或联合显示预后价值。讨论:影像、临床和基于心电图的左室纤维化替代品可能是房颤和左室sd患者LVEF改善的ca前标志物。然而,应考虑手术结果的混杂效应。综合风险分层工具在风险分层和患者选择方面具有临床应用价值;然而,前瞻性研究是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arrhythmia & Electrophysiology Review
Arrhythmia & Electrophysiology Review CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.10
自引率
6.70%
发文量
22
审稿时长
7 weeks
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