CA in AF With LVSD With and Without LV Fibrosis

IF 7.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2026-10-01 Epub Date: 2026-06-04 DOI:10.1016/j.jacep.2026.04.028

Louise Segan MBBS, MPH, PhD, Peter M. Kistler MBBS, PhD, Kenneth Cho MBBS, Shane Nanayakkara MBBS, PhD, David M. Kaye MBBS, PhD, Benedict Costello MBBS, PhD, Hitesh Patel MBBS, PhD, Hariharan Sugumar MBBS, PhD, Aleksandr Voskoboinik MBBS, PhD, Liang-Han Ling MBBS, PhD, Richard Schilling MBBS, MRCP, MD, Manuja Premaratne MBBS, PhD, Joseph B. Morton MBBS, PhD, Jonathan M. Kalman MBBS, PhD, Sandeep Prabhu MBBS, PhD

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引用次数: 0

Abstract

Background

Catheter ablation (CA) improves outcomes in atrial fibrillation (AF) with left ventricular systolic dysfunction (LVSD), but the influence of LV fibrosis remains unclear.

Objectives

This study sought to compare outcomes of CA in patients with AF and LVSD stratified by the presence or absence of LV late gadolinium enhancement (LGE) on cardiac magnetic resonance.

Methods

Patients from the CAMERA-MRI II (Catheter Ablation Versus Medical Rate Control of the Atrial Fibrillation With Systolic Heart Failure and Myocardial Fibrosis—an MRI Guided Multi-Centre Randomised Controlled Clinical Trial) randomized study were classified as LGE positive (LV LGE burden ≥5%) or LGE negative (<5%) and all underwent CA. Outcomes at 12 months included change in left ventricular ejection fraction (LVEF), LVEF normalization, AF burden, functional capacity, and heart failure hospitalization.

Results

Eighty patients underwent CA (40 LGE positive and 40 LGE negative). Both groups demonstrated substantial improvement in LVEF (LGE positive: ΔLVEF +20.3 ± 11.0%; LGE negative: +21.7 ± 11.8%; P = 0.578 for between-group difference in change). Unadjusted 12-month LVEF was lower in LGE-positive patients (49.1 ± 11.3% vs 54.5 ± 9.0%; P = 0.019); however, after adjustment for baseline cardiac magnetic resonance and markers of baseline disease severity, LGE status was not independently associated with 12-month LVEF (P = 0.849). Fewer LGE-positive patients achieved LVEF normalization (LVEF ≥50% in 52% vs 82% in LGE negative; P = 0.004), whereas arrhythmia-free survival and AF burden reduction were comparable. Improvements in biomarkers, functional status, and quality of life occurred in both groups. Higher LGE burden (>20%) was associated with attenuated LVEF recovery.

Conclusions

In AF with LVSD, CA is associated with substantial improvement in LV systolic function and clinical status regardless of LGE status. Absolute 12-month LVEF and normalization rates are lower in LGE-positive patients, consistent with greater baseline disease severity, whereas higher scar burden appears to modulate the magnitude of recovery and may inform expectations regarding outcomes.

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伴有和不伴有左室纤维化的房颤伴左室sd的CA：来自CAMERA-MRI II试验的结果。

背景：导管消融（CA）改善心房颤动（AF）合并左室收缩功能障碍（LVSD）的预后，但左室纤维化的影响尚不清楚。目的：本研究旨在比较房颤和LVSD患者的CA结果，并根据心脏磁共振是否存在LV晚期钆增强（LGE）进行分层。方法：来自CAMERA-MRI II（导管消融与收缩期心力衰竭和心肌纤维化房颤的医疗率控制-一项MRI引导的多中心随机对照临床试验）随机研究的患者分为LGE阳性（LV LGE负荷≥5%）或LGE阴性(结果：80例患者接受了CA（40例LGE阳性和40例LGE阴性）。两组LVEF均有明显改善（LGE阳性：ΔLVEF +20.3±11.0%；LGE阴性：+21.7±11.8%；组间变化差异P = 0.578）。lge阳性患者未调整的12个月LVEF较低（49.1±11.3% vs 54.5±9.0%;P = 0.019）；然而，在调整基线心脏磁共振和基线疾病严重程度标志物后，LGE状态与12个月LVEF没有独立相关性（P = 0.849）。较少的LGE阳性患者达到LVEF正常化（52%的患者LVEF≥50%，而LGE阴性患者LVEF≥82%，P = 0.004），而无心律失常生存和房颤负担减轻是相当的。两组患者的生物标志物、功能状态和生活质量均有改善。较高的LGE负担（>20%）与LVEF恢复减弱相关。结论：在合并LVSD的房颤中，无论LGE状态如何，CA与左室收缩功能和临床状态的显著改善相关。在lge阳性患者中，12个月LVEF绝对值和正常化率较低，这与基线疾病严重程度较高一致，而较高的疤痕负担似乎调节了恢复的程度，并可能告知对结果的预期。

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

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.