Heart Failure -> Heart Failure Management: -> Clinical Trials D-AB14 - Atrial Fibrillation in Heart Failure (ID 43) Abstract Plus

D-AB14-01 - The Problem Of Non-response To Catheter Ablation Treatment In Patients With Atrial Fibrillation And Reduced Ejection Fraction (ID 1434)


Background: Functional recovery following catheter ablation of atrial fibrillation (AFCA) results in left ventricular (LV) reverse remodeling (LVRR) in patients with AF and reduced LV ejection fraction (LVEF). However, some patients were still “non-response” to the AFCA treatment.
Objective: To investigate the predictors of “non-response” and its association with AF recurrence and clinical outcomes.
Methods: Of 3116 consecutive patients who underwent first-time AFCA at our institute, 353 patients who had a baseline LVEF of <50% were enrolled. They were subjected to 256-slice multidetector computed tomography (MDCT) scanning at baseline and 3-months after AFCA. Lack of LVRR, defined as a decrease in LV end-systolic volume by <15%, was considered as “non-response”.
Results: In this cohort, 65 patients (18%) did not develop LVRR and exhibited “non-response.” Multivariate logistic regression analysis, after adjusting for age, diabetes status, beta-blocker use, and LV diastolic diameter, revealed that predictors of “non-response” were paroxysmal AF (odds ratio, 2.55; 95% confidence interval, 1.32-4.96; p=0.006) and presence of underlying structural heart disease (SHD) (3.79; 1.76-8.18; p<0.001). The prevalence of “non-response” differed depending on AF recurrence pattern prior to post-MDCT (no vs. paroxysmal [lasting <7 days] vs. persistent episode [lasting ≥7 days], 16% vs. 18% vs. 38%, respectively, p=0.004). During a median follow-up of 28 months, the incidence of heart failure hospitalizations (17% vs. 2.1%, p<0.001), cardiovascular deaths (4.7% vs. 0.4%, p=0.002), and all-cause deaths (4.7% vs. 1.1%, p=0.035) were more frequent in patients with “non-response”.
Conclusion: “Non-response” to the AFCA treatment, predicted by paroxysmal AF with SHD at baseline, related to unfavorable clinical outcomes in patients with AF and reduced LVEF. Although “non-response” was associated with AF recurrence, the prevalence was <40% even among patients with persistent AF recurrence, which indicated that the concept of “non-response” was different from mere AF recurrence.