Contractile reserve is associated with response to catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction

Abstract Background Although patients with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) can benefit from catheter ablation, some patients do not respond. Prospectively identifying responders is challenging. Contractile Reserve (CR) on Exercise Stress Echocardiography (ESE) has demonstrated stratifying value before cardiac resynchronisation therapy but has not been evaluated in the setting of AF. Objective To evaluate whether CR on ESE was associated with response to CA in patients with LVSD. Methods Patients with persistent AF and LVSD (LVEF <50%) undergoing first-time catheter ablation were enrolled in the AFHF study. Patients underwent trans-thoracic echocardiography at rest and maximum exertion using a recumbent cycle ergometer. CR was the difference in LVEF at maximum exertion versus rest. Echocardiography was repeated six months after successful catheter ablation to determine Response based on the Universal Definition of Heart Failure improvement (LVEF +10%, or if baseline LVEF >40% then LVEF>50%). Results 52 patients were enrolled with baseline demographics in Table 1. 39 patients completed follow-up with 32 (82%) being responders. Responders had greater CR than non-responders (+10% (+5, +12) vs 3% (0, +4), (p=0.008)). A CR ≥ 5% had a positive predictive value of 0.96 for Response in this cohort. The AUROC was 0.83 with a specificity of 0.86. This was also associated with significant improvement in reported Minnesota living with HF scores (p<0.01). Conclusion CR was associated with response to CA in patients with persistent AF and LVSD in this exploratory analysis. Validation in an external cohort is needed to evaluate fit before prospective evaluation of its clinical utility.Baseline CharacteristicsROC curve for response to ablation