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

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.