THE ANTWERP score could predict the patients who are most likely to have improved heart failure symptoms after treatment after atrial fibrillation ablation, according to novel data presented at the Annual Congress of the European Heart Rhythm Association (EHRA). The score utilises clinical values to identify patients whose left ventricular ejection fraction (LVEF) would improve after atrial fibrillation ablation.
This score, which ranges from 0–6, with 0 being a sign of greater odds of LVEF recovery, is based on four parameters: known aetiology, worth two points; QRS width above 120 ms, worth two points, severe atrial dilation, worth one point; and paroxysmal atrial fibrillation, worth one point. The study included a cohort of 605 patients with heart failure with impaired LVEF and concomitant atrial fibrillation, who had undergone an ablation. Echocardiography was performed before and 12 months after atrial fibrillation ablation to assess LVEF. The primary endpoint of the study was sufficient improvement in ejection fraction, which was defined as an increase to LVEF of 50% or more, with a baseline LVEF of 40–50%, or an increase of at least 10% and second measurement of LVEF >40% at 12 months, with a baseline LVEF of 40% or less.
Results showed that 70% of participants had an improvement in ejection fraction and were more likely to have lower mortality, fewer heart failure hospitalisations, and positive ventricular remodelling compared with those who did not meet criteria for improvement. The score predicted improvement with an area under the curve of 0.86 (95% confidence interval: 0.82–0.89; p<0.001). Improvement in ejection fraction after ablation was detected in 94% of patients, with a score of 0, 92% of those with 1 point, 82% of those with 2 points, 51% of patients with 3 points, 40% of those with 4 points, and 17% of those with 5 or 6 points.
Researchers concluded that those with a low score (≤2) have more than 90% chance of recovery and would benefit from an early referral for catheter ablation, while those with a high score (≥5) have an expected recovery rate below 20% and could benefit from other strategies, including aggressive rate control. For those with a score of 3–4, with an expected recovery rate of 47%, further diagnostic tests may be beneficial.
“Further evidence is needed to help stratify and identify those patients who will most likely benefit from atrial fibrillation ablation,” stated Marco Bergonti, Cardiocentro Ticino Institute – Ente Ospedaliero Cantonale (EOC) Hospitals and Health Care, Lugano, Switzerland, and PhD student at the University of Antwerp, Belgium.