Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 18;40(6):1359-1369.
doi: 10.1002/joa3.13162. eCollection 2024 Dec.

Performance of the novel ANTWERP score in predicting heart function improvement after atrial fibrillation ablation in Asian patients with heart failure

Lo-Chieh Ling  1   2   3 , Ting-Yung Chang  1   2   3   4 , Yenn-Jiang Lin  1   2   3   5 , Chin-Yu Lin  1   2   3 , Shih-Lin Chang  1   2   3 , Li-Wei Lo  1   2   3 , Yu-Feng Hu  1   2   3 , Fa-Po Chung  1   2   3 , Shih-Ann Chen  1   3   5   6
Affiliations

Performance of the novel ANTWERP score in predicting heart function improvement after atrial fibrillation ablation in Asian patients with heart failure

Lo-Chieh Ling et al. J Arrhythm. .

Abstract

Background: Previous research has demonstrated that atrial fibrillation (AF) ablation improves heart function variably among patients. We proposed that the ANTWERP score, which was validated in a European group of patients with low left ventricular ejection fraction (LVEF) who had AF ablation, would be valid in an Asian group as well. The purpose of the study is to examine how well a new scoring system (the ANTWERP score) can predict heart function improvement after atrial fibrillation ablation in Asian patients with heart failure.

Methods: A retrospective review was conducted on patients (n = 84) undergoing AF ablation between January 2019 and June 2022. Initial diagnoses for impaired LV systolic function were confirmed by echocardiography. Patients meeting the "2021 Universal Definition of HF" criteria for LVEF recovery were classified as "responders."

Results: Similarities were observed between responders and nonresponders regarding comorbidities, AF type, and LVEF, except for the left ventricular internal diameter in diastole. A higher percentage of responders had an ANTWERP score ≤2 (87.8%) compared to those with a score >2 (55.6%). LVEF improvement was notably higher in the former group (+14.8% vs. +9.4%, p = .043). Atrial reverse remodeling and recurrent atrial arrhythmia rates were similar across groups.

Conclusion: The conclusion of the study was that the ANTWERP score effectively predicted LVEF improvement after atrial fibrillation ablation in the Asian population and that this scoring system could be used to guide clinical decisions and prognosis prediction.

Keywords: ANTWERP score; ablation; atrial fibrillation; ejection fraction; heart failure.

PubMed Disclaimer

Conflict of interest statement

Authors declare no conflict of interests for this article.

Figures

FIGURE 1
FIGURE 1
Patient allocation and analysis. AF, Atrial fibrillation; LVEF, Left ventricular ejection fraction; HF, Heart failure. Responders were identified (i) in case of baseline LVEF between 40% and 50% (HF with mildly reduced ejection fraction): LVEF improvement to more than ≥50% and (ii) in case of baseline LVEF <40% (HF with reduced ejection fraction): ≥10% absolute increase from baseline LVEF, and LVEF >40%.
FIGURE 2
FIGURE 2
Comparison of baseline and follow‐up echocardiography parameters in (A) patients with ANTWERP Score 0–2 and (B) patients with ANTWERP Score 3–6. LV, Left ventricular; LAD, Left atrium diameter; LVIDd, LV internal diameter at end‐diastole; LVIDs, LV internal diameter at end‐systole; IVSd, Interventricular septum thickness at end‐diastole; LVPWd, LV posterior wall thickness at end‐diastole; LVESV, LV end‐systolic volume; LVEDV, LV end‐diastolic volume; LVEF, Left ventricular ejection fraction; PASP, Pulmonary artery systolic pressure.
FIGURE 3
FIGURE 3
Comparison of atrial arrhythmia recurrence between patients with ANTWERP Score 0–2 and ANTWERP Score 3–6. AF, Atrial fibrillation. (A) Kaplan–Meier analysis depicting the cumulative event rates for the composite endpoints of atrial arrhythmia recurrence in two groups: ANTWERP Score 0–2 and ANTWERP Score 3–6. (B) Kaplan–Meier analysis depicting the cumulative event rates for the composite endpoint of the heart failure hospitalization in two groups: ANTWERP Score 0–2 and ANTWERP Score 3–6.
See this image and copyright information in PMC

References

    1. Larned JM, Raja Laskar S. Atrial fibrillation and heart failure. Congest Heart Fail. 2009;15(1):24–30. - PubMed
    1. Verma A, Kalman JM, Callans DJ. Treatment of patients with atrial fibrillation and heart failure with reduced ejection fraction. Circulation. 2017;135(16):1547–1563. - PubMed
    1. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham heart study. Circulation. 2003;107(23):2920. - PubMed
    1. Brachmann J, Sohns C, Andresen D, Siebels J, Sehner S, Boersma L, et al. Atrial fibrillation burden and clinical outcomes in heart failure: the CASTLE‐AF trial. JACC Clin Electrophysiol. 2021;7(5):594–603. - PubMed
    1. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125–e151. - PubMed