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. 2023 Oct;10(5):3055-3066.
doi: 10.1002/ehf2.14448. Epub 2023 Aug 18.

Atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy: a prospective multicentre study

Teba González-Ferrero  1   2   3 , Marco Bergonti  4   5   6 , José Nicolás López-Canoa  3   7 , Federico García-Rodeja Arias  1   2   3 , Sonia Eiras Penas  2   3 , Francesco Spera  4   5 , Adrián González-Maestro  2 , Carlos Minguito-Carazo  1   2   3 , José Luis Martínez-Sande  1   2   3 , Laila González-Melchor  1   2   3 , Francisco Javier García-Seara  1   2   3 , Jesús Alberto Fernández-López  1   2   3 , Ezequiel Álvarez-Castro  2   3 , José Ramón González-Juanatey  1   2   3 , Hein Heidbuchel  4   5 , Andrea Sarkozy  4   5 , Moisés Rodríguez-Mañero  1   2   3
Affiliations

Atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy: a prospective multicentre study

Teba González-Ferrero et al. ESC Heart Fail. 2023 Oct.

Abstract

Aims: This study aims to investigate the clinical and biochemical characteristics of patients with atrial fibrillation (AF) referred for ablation who develop arrhythmia-induced cardiomyopathy (AiCM) as well as their long-term outcomes after catheter ablation (CA).

Methods and results: A prospective multicentre study was conducted on consecutive AF patients who underwent CA. AiCM was defined as the development of heart failure in the presence of AF and an improvement of left ventricular fraction by at least 10% at 6 months after ablation. A subgroup of patients underwent peripheral and left atrial blood samples [galectin-3, fatty acid-binding protein 4 (FABP4), and soluble receptor for advanced glycation end products (sRAGE)] at the time of the procedure. Of the 769 patients who underwent AF ablation, 135 (17.56%) met the criteria for AiCM. Independent predictors of AiCM included persistent AF, male gender, left atrial volume, QRS width, active smoking, and chronic kidney disease (CKD). Biomarker analysis revealed that sRAGE, FABP4, and galectin-3 levels were not predictive of AiCM development nor did they differ between groups or predict recurrence. There were no differences in AF recurrence between patients with and without AiCM (30.83% vs. 27.77%; P = 0.392) during a median follow-up of 23.83 months (inter-quartile range 9-36).

Conclusions: In the subset of patients referred for AF ablation, the development of AiCM was associated with persistent AF and CKD. Biomarker analysis was not different between groups nor predicted recurrence. Patients with AiCM benefited from ablation, with a significant improvement in left ventricular ejection fraction and similar AF recurrence rates to those without AiCM.

Keywords: Atrial fibrillation; Catheter ablation; Heart failure.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Kaplan–Meier curves showing atrial fibrillation recurrence‐free survival. AiCM, arrhythmia‐induced cardiomyopathy.
Figure 2
Figure 2
Improvement of left ventricular ejection fraction (LVEF) after catheter ablation in patients with arrhythmia‐induced cardiomyopathy (AiCM).
Figure 3
Figure 3
Example of a 60‐year‐old patient who had been admitted for HF with severely depressed left ventricular ejection fraction and experienced complete normalization of left ventricular systolic function after ablation. Despite long‐standing persistent atrial fibrillation and 60% of low‐voltage zone on the bipolar voltage map, he maintained sinus rhythm during 2 years of follow‐up.
Figure 4
Figure 4
Central illustration. This figure summarizes the key points of our study. It includes the results of our analysis to identify the independent predictors for arrhythmia‐induced cardiomyopathy (AiCM) development. The Kaplan–Meier curves represent that no differences in the rate of recurrence were found during long‐term follow‐up after atrial fibrillation (AF) ablation between both groups. CI, confidence interval; CKD, chronic kidney disease; EF, ejection fraction; LAVi, left atrial volume index; OR, odds ratio; PVI, pulmonary vein isolation.
See this image and copyright information in PMC

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