Prognostic Impact of Diagnosis-to-Ablation Time on Outcomes Following Catheter Ablation in Persistent Atrial Fibrillation and Left Ventricular Systolic Dysfunction

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dc.contributor.authorSegan, L.
dc.contributor.authorKistler, P.M.
dc.contributor.authorChieng, D.
dc.contributor.authorCrowley, R.
dc.contributor.authorWilliam, J.
dc.contributor.authorCho, K.
dc.contributor.authorSugumar, H.
dc.contributor.authorLing, L.-H.
dc.contributor.authorVoskoboinik, A.
dc.contributor.authorHawson, J.
dc.contributor.authorMorton, J.B.
dc.contributor.authorLee, G.
dc.contributor.authorSanders, P.
dc.contributor.authorKalman, J.M.
dc.contributor.authorPrabhu, S.
dc.date.issued2025
dc.descriptionAvailable online 27 September 2024
dc.description.abstractBackground: The optimal timing of catheter ablation in individuals with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) remains uncertain. Objective: We examined whether AF diagnosis to ablation time (DAT) influences outcomes following catheter ablation(CA) in patients with persistent AF (PsAF) and LVSD from the CAMERA MRI and CAPLA randomized studies. Methods: We evaluated clinical outcomes according to DAT <1 year (“shorter DAT”) and >1 year (“longer DAT”), comparing AF recurrence, AF burden, left ventricular ejection fraction (LVEF) and LV recovery (LVEF>50%) at 12 months. DAT was also compared according to the median (24 months). Results: 210 individuals with AF and LVSD were identified, with a median DAT of 24 months. Shorter DAT was associated with lower LA global and posterior wall scar (<0.05mV; both p<0.05). At 12 months, 69.4% with shorter DAT (<1year) were free from recurrent atrial arrhythmias vs 53.6% in longer DAT (HR 1.63, 95% CI 1.01-2.65 p=0.040). Median AF burden was 0% in both groups (shorter DAT:IQR 0.0-2.0% vs longer DAT:IQR 0.0-7.3%,p=0.017). At 12 months, shorter DAT was associated with higher LVEF (55.3% vs 51.0%, p=0.009), greater LVEF improvement (+20.8±13.0% vs +13.9±13.2% longer DAT, p<0.001) and LV recovery (75.0% vs longer DAT: 57.2%, p=0.011). Shorter DAT was associated with fewer hospitalisations and electrical cardioversions at 12 months. Conclusions: In individuals with AF and LVSD, shorter DAT was associated with greater LVEF improvement and arrhythmia-free survival with lower AF burden and rehospitalization at 12 months, highlighting the prognostic benefit of early CA in AF and LVSD.
dc.description.statementofresponsibilityLouise Segan, Peter M. Kistler, David Chieng, Rose Crowley, Jeremy William, Kenneth Cho, Hariharan Sugumar, Liang-Han Ling, Aleksandr Voskoboinik, Joshua Hawson, Joseph B. Morton, Geoffrey Lee, Prashanthan Sanders, Jonathan M. Kalman, and Sandeep Prabhu
dc.identifier.citationHeart Rhythm, 2025; 22(6):1429-1436
dc.identifier.doi10.1016/j.hrthm.2024.09.059
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/142736
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2017798
dc.rightsCrown Copyright © 2024 Published by Elsevier Inc. on behalf of Heart Rhythm Society. All rights are reserved, including those for text and data mining, AI training, and similar technologies.c
dc.source.urihttp://dx.doi.org/10.1016/j.hrthm.2024.09.059
dc.subjectatrial fibrillation
dc.subjectcatheter ablation
dc.subjectleft ventricular systolic dysfunction
dc.subjectLV recovery
dc.subjectpulmonary vein isolation
dc.subjectremodeling
dc.titlePrognostic Impact of Diagnosis-to-Ablation Time on Outcomes Following Catheter Ablation in Persistent Atrial Fibrillation and Left Ventricular Systolic Dysfunction
dc.typeJournal article
pubs.publication-statusPublished

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