학술논문
Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model.
Document Type
Academic Journal
Author
Bergonti M; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland.; Ascione C; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.; Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.; Marcon L; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.; Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Pambrun T; Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.; L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France.; Della Rocca DG; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.; Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.; Ferrero TG; Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain.; Pannone L; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.; Kühne M; Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.; Compagnucci P; Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy.; Bonomi A; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.; Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Gevaert AB; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.; Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.; Anselmino M; Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy.; Casella M; Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I-Lancisi-Salesi', Ancona, Italy.; Krisai P; Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.; Tondo C; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.; Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Rodríguez-Mañero M; Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS, Santiago de Compostela, Spain.; Derval N; Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.; L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France.; Chierchia GB; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.; de Asmundis C; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.; Heidbuchel H; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.; Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.; Jaïs P; Electrophysiology and Ablation Unit, Hospital Haut-Lévêque, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.; L'Institut de RYthmologie et modélisation Cardiaque (LIRYC) ANR-10-IAHU-04, Université de Bordeaux, Bordeaux, France.; Sarkozy A; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.; Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 8006263 Publication Model: Print Cited Medium: Internet ISSN: 1522-9645 (Electronic) Linking ISSN: 0195668X NLM ISO Abbreviation: Eur Heart J Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: Management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains complex. The Antwerp score, based on four parameters [QRS >120 ms (2 points), known aetiology (2 points), paroxysmal AF (1 point), severe atrial dilation (1 point)] adequately estimated the probability of left ventricular ejection fraction (LVEF) recovery after AF ablation in a single-centre cohort. The present study aims to externally validate this prediction model in a large European multi-centre cohort.
Methods and Results: A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001).
Conclusion: In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Methods and Results: A total of 605 patients (61.1 ± 9.4 years, 23.8% females, 79.8% with persistent AF) with HF and impaired LVEF (<50%) undergoing AF ablation in 8 European centres were retrospectively identified. According to the LVEF changes at 12-month echocardiography, 427 (70%) patients fulfilled the '2021 Universal Definition of HF' criteria for LVEF recovery and were defined as 'responders'. External validation of the score yielded good discrimination and calibration {area under the curve 0.86 [95% confidence interval (CI) 0.82-0.89], P < .001; Hosmer-Lemeshow P = .29}. Patients with a score < 2 had a 93% probability of LVEF recovery as opposed to only 24% in patients with a score > 3. Responders experienced more often positive ventricular remodelling [odds ratio (OR) 8.91, 95% CI 4.45-17.84, P < .001], fewer HF hospitalizations (OR 0.09, 95% CI 0.05-0.18, P < .001) and lower mortality (OR 0.11, 95% CI 0.04-0.31, P < .001).
Conclusion: In this multi-centre study, a simple four-parameter score predicted LVEF recovery after AF ablation in patients with HF and discriminated clinical outcomes. These findings support the use of the Antwerp score to standardize shared decision-making regarding AF ablation referral in future clinical studies.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)