TY - JOUR
T1 - The impact of age on ablation outcomes in AF-mediated cardiomyopathy
AU - Segan, Louise
AU - Chieng, David
AU - Sugumar, Hariharan
AU - Voskoboinik, Aleksandr
AU - Ling, Liang Han
AU - Costello, Ben
AU - Azzopardi, Sonia
AU - Nderitu, Ziporah
AU - Parameswaran, Ramanathan
AU - Amerena, John
AU - McLellan, Alex J.
AU - Lee, Geoffrey
AU - Morton, Joseph
AU - Joseph, Stephen
AU - Wong, Michael
AU - Taylor, Andrew
AU - Kalman, Jonathan M.
AU - Kistler, Peter M.
AU - Prabhu, Sandeep
N1 - Funding Information:
Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians.
Funding Information:
: L. S. is supported by cofunded NHMRC/NHF postgraduate scholarship. The following industry funding sources regarding activities outside the submitted work have been declared in accordance with ICMJE guidelines. P. M. K. has received funding from Abbott Medical for consultancy and speaking engagements and has served on the advisory board with fellowship support from Biosense Webster. J. M. K. has received fellowship support from Medtronic and Biosense Webster. G. L. has received consulting fees from Biosense Webster. S. P is suported by NHMRC post doctoral fellowship and has received fees from Abbott Medical and Biosense Webster for consultancy and speaking engagements. Other authors: No disclosures. Disclosures
Publisher Copyright:
© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: The absence of ventricular scar in patients with atrial fibrillation (AF) and systolic heart failure (HF) predicts left ventricular (LV) recovery following AF ablation. It is unknown whether age impacts the degree of LV recovery, reverse remodeling, or AF recurrence following catheter ablation (CA) among this population. Objectives: To evaluate the impact of age on LV recovery and AF recurrence in a population with AF and systolic HF without fibrosis (termed AF-mediated cardiomyopathy) following CA. Methods: Consecutive patients undergoing CA between 2013 and 2021 with LV ejection fraction (LVEF) < 45% and absence of cardiac magnetic resonance imaging (CMR) detected LV myocardial fibrosis were stratified by age (<65 vs. ≥65 years). Following CA, participants underwent remote rhythm monitoring for 12 months with repeat CMR for HF surveillance. Results: The study population consisted of 70 patients (10% female, mean LVEF 33 ± 9%), stratified into younger (age < 65 years, 63%) and older (age ≥ 65 years, 37%) cohorts. Baseline comorbidities, LVEF (34 ± 9 vs. 33 ± 8 ≥65 years, p =.686), atrial and ventricular dimensions (left atrial volume index: 55 ± 21 vs. 56 ± 14 mL/m2 age ≥ 65, p =.834; indexed left ventricular end-diastolic volume: 108 ± 40 vs. 104 ± 28 mL/m2 age ≥ 65, p =.681), pharmacotherapy and ablation strategy (pulmonary vein isolation in all; posterior wall isolation in 27% vs. 19% age ≥ 65, p =.448; cavotricuspid isthmus in 9% vs. 11.5% age ≥ 65) were comparable (all p >.05) albeit a higher CHADS2VASc score in the older cohort (2.7 ± 0.9 vs. 1.6 ± 0.6 age < 65, p <.001). Freedom from AF was comparable (hazard ratio: 0.65, 95% confidence interval: 0.38–1.48, LogRank p =.283) as was AF burden [0% (interquartile range, IQR: 0.0–2.1) vs. age ≥ 65: [0% (IQR 0.0–1.7), p =.516], irrespective of age. There was a significant improvement in LV systolic function in both groups (ΔLVEF + 21 ± 14% vs. +21 ± 12% age ≥ 65, p =.913), with LV recovery in the vast majority (73% vs. 69%, respectively, p =.759) at 13 (IQR: 12–16) months. This was accompanied by comparable improvements in functional status (New York Heart Association class p =.851; 6-min walk distance 50 ± 61 vs. 93 ± 134 m in age ≥ 65, p =.066), biomarkers (ΔN-terminal-pro brain natriuretic peptide −139 ± 246 vs. −168 ± 181 age ≥ 65,p =.629) and HF symptoms (Short Form-36 survey Δphysical component summary p =.483/Δmental component summary, p =.841). Conclusion: In patients undergoing CA for AF with systolic HF in the absence of ventricular scar, comparable improvements in ventricular function, symptoms, and freedom from AF are achieved irrespective of age.
AB - Introduction: The absence of ventricular scar in patients with atrial fibrillation (AF) and systolic heart failure (HF) predicts left ventricular (LV) recovery following AF ablation. It is unknown whether age impacts the degree of LV recovery, reverse remodeling, or AF recurrence following catheter ablation (CA) among this population. Objectives: To evaluate the impact of age on LV recovery and AF recurrence in a population with AF and systolic HF without fibrosis (termed AF-mediated cardiomyopathy) following CA. Methods: Consecutive patients undergoing CA between 2013 and 2021 with LV ejection fraction (LVEF) < 45% and absence of cardiac magnetic resonance imaging (CMR) detected LV myocardial fibrosis were stratified by age (<65 vs. ≥65 years). Following CA, participants underwent remote rhythm monitoring for 12 months with repeat CMR for HF surveillance. Results: The study population consisted of 70 patients (10% female, mean LVEF 33 ± 9%), stratified into younger (age < 65 years, 63%) and older (age ≥ 65 years, 37%) cohorts. Baseline comorbidities, LVEF (34 ± 9 vs. 33 ± 8 ≥65 years, p =.686), atrial and ventricular dimensions (left atrial volume index: 55 ± 21 vs. 56 ± 14 mL/m2 age ≥ 65, p =.834; indexed left ventricular end-diastolic volume: 108 ± 40 vs. 104 ± 28 mL/m2 age ≥ 65, p =.681), pharmacotherapy and ablation strategy (pulmonary vein isolation in all; posterior wall isolation in 27% vs. 19% age ≥ 65, p =.448; cavotricuspid isthmus in 9% vs. 11.5% age ≥ 65) were comparable (all p >.05) albeit a higher CHADS2VASc score in the older cohort (2.7 ± 0.9 vs. 1.6 ± 0.6 age < 65, p <.001). Freedom from AF was comparable (hazard ratio: 0.65, 95% confidence interval: 0.38–1.48, LogRank p =.283) as was AF burden [0% (interquartile range, IQR: 0.0–2.1) vs. age ≥ 65: [0% (IQR 0.0–1.7), p =.516], irrespective of age. There was a significant improvement in LV systolic function in both groups (ΔLVEF + 21 ± 14% vs. +21 ± 12% age ≥ 65, p =.913), with LV recovery in the vast majority (73% vs. 69%, respectively, p =.759) at 13 (IQR: 12–16) months. This was accompanied by comparable improvements in functional status (New York Heart Association class p =.851; 6-min walk distance 50 ± 61 vs. 93 ± 134 m in age ≥ 65, p =.066), biomarkers (ΔN-terminal-pro brain natriuretic peptide −139 ± 246 vs. −168 ± 181 age ≥ 65,p =.629) and HF symptoms (Short Form-36 survey Δphysical component summary p =.483/Δmental component summary, p =.841). Conclusion: In patients undergoing CA for AF with systolic HF in the absence of ventricular scar, comparable improvements in ventricular function, symptoms, and freedom from AF are achieved irrespective of age.
KW - AF-mediated cardiomyopathy
KW - atrial fibrillation
KW - catheter ablation
KW - elderly
KW - heart failure
KW - myocardial fibrosis
UR - https://www.scopus.com/pages/publications/85170516225
U2 - 10.1111/jce.16052
DO - 10.1111/jce.16052
M3 - Article
C2 - 37694615
AN - SCOPUS:85170516225
SN - 1045-3873
VL - 34
SP - 2065
EP - 2075
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 10
ER -