Novel score identifies those likely to improve heart failure symptoms after AF ablation
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Key takeaways:
- A novel score identified those most likely to have improved heart failure symptoms after atrial fibrillation ablation.
- It uses readily available data including QRS width, known etiology and AF subtype.
The novel ANTWERP score demonstrated good predictive value in identifying patients whose heart failure symptoms would improve after ablation for atrial fibrillation, a speaker reported.
The score utilized readily available clinical values including QRS width, known etiology, AF subtype and atrial dilation to identify those who may experience improved left ventricular ejection fraction after AF ablation, according to the findings from the ANTWOORD study presented at the Annual Congress of the European Heart Rhythm Association.
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“The tools to help clinicians determine who exactly these selected patients are and which patients have tachycardia-mediated cardiomyopathy are elusive and often subjective,” Marco Bergonti, MD, of the Cardiocentro Ticino Institute - EOC, Lugano, Switzerland and a PhD student at the University of Antwerp, Belgium, said in a press release. “Further evidence is needed to help stratify and identify those patients who will most likely benefit from atrial fibrillation ablation. The ANTWERP score was developed to predict the response to ablation in heart failure patients with impaired (below 50%) ejection fraction.”
For the ANTWOORD study, researchers externally validated the ANTWERP score in a cohort of 605 patients with HF with impaired LVEF and concomitant AF who underwent an ablation procedure at eight centers in Europe.
ANTWERP scores range from 0 to 6 points, with 0 points indicating greater odds of LVEF recovery, and is based on four parameters:
- QRS width above 120 milliseconds is worth 2 points.
- Known etiology is worth 2 points.
- Paroxysmal AF is worth 1 point.
- Severe atrial dilation is worth 1 point.
Participants underwent echocardiography to assess LVEF before and 12 months after AF ablation.
The primary endpoint was sufficient improvement in EF defined as baseline LVEF of 40% to 50% and an increase to 50% or more, or a baseline LVEF of 40% or less and an increase of at least 10% from baseline and a second measurement of LVEF above 40% at 12 months.
Overall, 70% of participants had sufficient improvement in EF and were more likely to have positive ventricular remodeling (OR = 8.9; P < .001), fewer HF hospitalizations (OR = 0.09; P < .001) and lower mortality (OR = 0.11; P < .001) compared with participants who did not meet criteria for improvement.
The researchers reported that the ANTWERP score predicted improvement in LVEF after AF ablation with an area under the curve of 0.86 (95% CI, 0.82-0.89; P < .001).
Overall, 94% of patients with a score of 0 experienced sufficient improvement in EF after ablation, followed by 92% with 1 point, 82% with 2 points, 51% with 3 points, 40% with 4 points and 17% with 5 or 6 points, according to the study.
“Based on our findings, patients with a low score (2 or less) may benefit from early referral for catheter ablation, with a more than 90% chance of recovery,” Bergonti said in the release. “Patients with a high score (5 or higher) have a very low expected recovery rate (below 20%) and hence may benefit more from alternative strategies such as aggressive rate control. Those in the intermediate zone (score 3-4, expected recovery rate 47%) may benefit from further diagnostic tests such as cardiac magnetic resonance to improve their diagnostic assessment, as the presence of late gadolinium enhancement has been associated with less LVEF improvement.”
Reference:
- European Society of Cardiology. www.escardio.org/The-ESC/Press-Office/Press-releases/novel-score-predicts-heart-failure-improvement-after-atrial-fibrillation-ablatio. Published April 18, 2023. Accessed April 19, 2023.
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Bergonti M, et al. Late Breaking Science - Today and tomorrow. Presented at: EHRA: The Annual Congress of the European Heart Rhythm Association; April 16-18, 2023; Barcelona, Spain.
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