Background

In patients with atrial fibrillation (AF) and heart failure (HF), pulmonary vein isolation (PVI) was shown to be superior to pharmacological therapy. However, only a variable percentage of patients improves and how these patients should be identified remains uncertain.

Objective

to investigate the predictors of left ventricular (LV) systolic function recovery after PVI and to develop a prediction model for individualised assessment.

Methods

We conducted an observational, retrospective, single centre study of consecutive patients with AF and HF undergoing PVI. Patients were divided into Responder vs. Non-Responder (NR) according to the ‘Universal definition and classification of HF’. Clinical predictors were evaluated by multivariate logistic regression analysis and cross-validation technique. Independent predictors were used to build an internally validated prediction model.

Results

One-hundred-and-eleven patients (61 ± 10 years, 61% male) were included and followed for 34 (20–58) months. Patients in the Responder group had significantly shorter QRS duration (97 vs. 137 ms, p < 0.001) and less dilated left atria (38 vs. 50 mL/m², p < 0.001). Persistent AF and concomitant AF-HF diagnoses were more frequent among Responders. AF/AFL/AT recurrence was 35% in the Responder vs. 49% in the Non-Responder group (p = 0.2). Time to recovery in the Responder-Group was 4.8 (0.6–10.4) months. The absence of known underlying Cardiomyopathy (CMP), persistent AF, left atrial volume index (LAVI) < 50ml/m², and QRS <120msec were significant predictors of systolic function recovery and were included in the Antwerp Score. Patients with Antwerp Score ≤1 had a 90% likelihood of Response compared to 5% in patients with ≥3 points.

Conclusions

HF Patients with systolic LV function recovery after PVI have less frequently wide QRS complex and known underlying CMP, less dilated left atria, and more frequently persistent AF. A new score system based on four clinical parameters (QRS duration, LA volume, persistent AF and known underlying CMP) can accurately predict LV function recovery after PVI.

中文翻译：

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摘要 选择用于口头报告的摘要 心力衰竭患者心房颤动导管消融后左心室收缩功能恢复的新预测模型。安特伍德研究

背景

在房颤 (AF) 和心力衰竭 (HF) 患者中，肺静脉隔离 (PVI) 被证明优于药物治疗。然而，只有不同比例的患者得到改善，如何识别这些患者仍不确定。

客观的

研究 PVI 后左心室 (LV) 收缩功能恢复的预测因素，并开发用于个体化评估的预测模型。

方法

我们对连续接受 PVI 的 AF 和 HF 患者进行了一项观察性、回顾性、单中心研究。根据“HF 的通用定义和分类”将患者分为有反应者与无反应者 (NR)。通过多变量逻辑回归分析和交叉验证技术评估临床预测因素。独立预测变量用于构建内部验证的预测模型。

结果

111 名患者（61 ± 10 岁，61% 男性）被纳入并随访 34（20-58）个月。Responder 组的患者 QRS 持续时间显着缩短（97 vs. 137 ms，p  < 0.001），左心房扩张较少（38 vs. 50 mL/m ²，p  < 0.001）。持续性 AF 和伴随的 AF-HF 诊断在响应者中更为常见。有反应者的 AF/AFL/AT 复发率为 35%，而无反应者组为 49% ( p  = 0.2)。响应者组的恢复时间为 4.8 (0.6–10.4) 个月。没有已知的潜在心肌病 (CMP)、持续性 AF、左心房容积指数 (LAVI) < 50ml/m ²和 QRS <120 毫秒是收缩功能恢复的重要预测指标，并被纳入安特卫普评分。安特卫普评分≤1 的患者有 90% 的缓解可能性，而 ≥3 分的患者有 5% 的缓解可能性。

结论

PVI 后左室收缩功能恢复的 HF 患者，QRS 波群宽和已知潜在 CMP 的频率较低，左心房扩张较少，持续性 AF 的频率较高。基于四个临床参数（QRS 持续时间、LA 体积、持续性 AF 和已知的潜在 CMP）的新评分系统可以准确预测 PVI 后 LV 功能的恢复。