Prognostic Significance of Post-Procedural Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Systolic Dysfunction

Background: Atrial fibrillation (AF) ablation is associated with a good prognosis; nevertheless, the effect of post-procedural systolic function on a patient’s prognosis remains uncertain. Methods and Results: Of 1,077 consecutive patients undergoing AF ablation, the prognosis of 150 patients with abnormal left ventricular ejection fraction (LVEF; <50%) was evaluated. Patients were categorized as having reduced LVEF (rEF; LVEF <40%), mid-range ejection fraction (mrEF; 40%≤LVEF<50%), or preserved LVEF (pEF; LVEF ≥50%). Post-procedural LVEF, evaluated 3 months after the procedure, was post-rEF in 28 patients (19%), post-mrEF in 49 (33%), and post-pEF in 73 (49%). During the median follow-up of 31 months, the cumulative ratios of the composite outcome (heart failure hospitalization or death) in the post-rEF, post-mrEF, and post-pEF groups were 18%, 5%, and 2%, respectively, at 1 year and 50%, 13%, and 4%, respectively, at 3 years (P<0.0001). The post-rEF group had a 4.5- to 5.0-fold higher risk of the outcome compared with the post-pEF group, whereas the post-mrEF group showed no risk after adjusting for confounders, including age ≥65 years, preprocedural LVEF category, and recurrence of atrial tachyarrhythmia. Conclusions: Patients with post-mrEF had a comparable prognosis to those with post-pEF over a relatively long follow-up, whereas those with post-rEF had the poorest outcome of the 3 groups, regardless of preprocedural LVEF status.