Evidence map›Paper›PMID 41083280›Full record

ArticleOpen heart2025

Withdrawing guideline-directed medical therapy after left ventricular ejection fraction recovery following atrial fibrillation ablation: a multicentre cohort study.

Sayed Al-Aidarous, Saffron Rajappan, Nikhil Ahluwalia, Christopher P Uy, Hatem Abdelgawad, Caterina Vidal Horrach, Sofiane Kouadria, Zhen Hua, Gurkiran Sandhar, Theo Cooke and 23 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

33 authors.

Sayed Al-AidarousSt Bartholomew's Hospital, London, UK.ORCID http://orcid.org/0000-0002-7044-9423
Saffron RajappanUCLMS, University College London Medical School, London, UK.
Nikhil AhluwaliaSt Bartholomew's Hospital, London, UK.ORCID http://orcid.org/0000-0003-1257-5576
Christopher P UySt Bartholomew's Hospital, London, UK.
Hatem AbdelgawadRoyal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
Caterina Vidal HorrachQueen Mary University of London, London, UK.
Sofiane KouadriaSt Bartholomew's Hospital, London, UK.
Zhen HuaSt Bartholomew's Hospital, London, UK.
Gurkiran SandharSt Bartholomew's Hospital, London, UK.
Theo CookeSt Bartholomew's Hospital, London, UK.ORCID http://orcid.org/0009-0008-8850-9560
Salman RasheedLister Hospital, Stevenage, UK.
Suria GeranBarking Havering and Redbridge Hospitals NHS Trust, Romford, UK.
Kayla Li Xian ChiewCardiology, Whittington Hospital, London, UK.ORCID http://orcid.org/0000-0002-9694-2494
Meher LehriHomerton University Hospital NHS Trust, London, UK.
Dimitrios PalaiologosLister Hospital, Stevenage, UK.
Arsalan KhalilCardiology, North Middlesex University Hospital, London, UK.
Brett KennedyRoyal Berkshire Hospital, Reading, UK.
Richard BalasubramaniamRoyal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
Shahana HussainSt Bartholomew's Hospital, London, UK.
Lauren StantonDorset County Hospital NHS Foundation Trust, Dorchester, UK.
Syed AhsanSt Bartholomew's Hospital, London, UK.
Christopher PrimusSt Bartholomew's Hospital, London, UK.
Anthony W C ChowSt Bartholomew's Hospital, London, UK.
Martin ThomasSt Bartholomew's Hospital, London, UK.
Amal MuthumalaSt Bartholomew's Hospital, London, UK.
Syed M A SohaibSt Bartholomew's Hospital, London, UK.
Richard AngSt Bartholomew's Hospital, London, UK.
Nikolaos PapageorgiouSt Bartholomew's Hospital, London, UK.
Charles ButcherDorset County Hospital NHS Foundation Trust, Dorchester, UK.
Kim RajappanCardiac Department, Oxford University Hospitals NHS Trust, Oxford, UK.ORCID http://orcid.org/0000-0001-8996-2983
Caroline RoneyQueen Mary University of London, London, UK.
Ross J HunterSt Bartholomew's Hospital, London, UK.
Shohreh HonarbakhshSt Bartholomew's Hospital, London, UK shohreh.honarbakhsh@nhs.net.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF)-induced cardiomyopathy (AIC) is characterised by reversible left ventricular (LV) dysfunction after restoration of sinus rhythm (SR). The need for continued guideline-directed medical therapy (GDMT) for heart failure after LV ejection fraction (LVEF) recovery in AIC after catheter ablation (CA) is unclear.

methodsThis multicentre cohort study across 12 UK centres included adults undergoing index AF ablation (June 2019-June 2024) with LVEF <50% preablation and recovery to ≥50% at three timepoints: preablation; early postablation (≥4 weeks) and late postablation (≥3 months or ≥3 months post-GDMT withdrawal). Patients were stratified post recovery of LVEF after CA. The primary outcome was mean LVEF at late follow-up; secondary outcomes included absolute change in LVEF, LV end-diastolic diameter (LVEDD) and SR maintenance.

results88 patients met inclusion enrolment criteria (61.7±10.6 years old; 91% male), of which 50 (56.8%) continued full-dose GDMT and 38 (43.2%) withdrew ≥50% of GDMT. In the GDMT-withdrawn group, mean GDMT classes decreased from 2.97±0.88 to 1.03±0.79 (p<0.001). At late follow-up, mean LVEF was comparable (56.3%±3.8% GDMT-continued vs 56.8%±5.5% GDMT-withdrawn; p=0.59), as was LVEF change (1.2% vs 0.4%; p=0.48). One relapse occurred in each group secondary to an acute coronary syndrome (2.0% vs 2.6%; p=1). LVEDD remained stable (p>0.8). SR was maintained in 82.0% vs 92.1% of patients; p=0.17.

conclusionsSelective GDMT withdrawal after sustained LVEF recovery and rhythm control did not compromise LV systolic function, remodelling or rhythm maintenance. This supports the study of personalised de-escalation strategies in AIC in prospective trials.

Indexed as

Anti-Arrhythmia AgentsAtrial FibrillationCatheter AblationPractice Guidelines as TopicStroke VolumeVentricular Dysfunction, LeftVentricular Function, LeftAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedRecovery of FunctionTime FactorsTreatment OutcomeAnti-Arrhythmia AgentsAtrial FibrillationCardiac CatheterizationHEART FAILUREHeart Failure, Systolic

Identifiers

PMID41083280
PMCPMC12519717

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.