{
  "abstract": "Background Atrial 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.Methods This 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.Results 88 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 In the GDMT-withdrawn group, mean GDMT classes decreased from 2.97±0.88 to 1.03±0.79 (p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 At late follow-up, mean LVEF was comparable (56.3%±3.8% GDMT-continued vs 56.8%±5.5% GDMT-withdrawn; p=0.59), as was LVEF change (1.2% vs 0.4%; p=0.48).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.Conclusions Selective 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.",
  "authors": [
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Queen Mary University of London, London, UK"
      ],
      "name": "Sayed Al-Aidarous"
    },
    {
      "affiliations": [
        "UCLMS, University College London Medical School, London, UK",
        "Cardiac Department, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Saffron Rajappan"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Nikhil Ahluwalia"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK"
      ],
      "name": "Christopher P Uy"
    },
    {
      "affiliations": [
        "Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, UK"
      ],
      "name": "Hatem Abdelgawad"
    },
    {
      "affiliations": [
        "Queen Mary University of London, London, UK"
      ],
      "name": "Caterina Vidal Horrach"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Sofiane Kouadria"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Queen Mary University of London, London, UK"
      ],
      "name": "Zhen Hua"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "UCLMS, University College London Medical School, London, UK"
      ],
      "name": "Gurkiran Sandhar"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Theo Cooke"
    },
    {
      "affiliations": [
        "Lister Hospital, Stevenage, UK"
      ],
      "name": "Salman Rasheed"
    },
    {
      "affiliations": [
        "Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK"
      ],
      "name": "Suria Geran"
    },
    {
      "affiliations": [
        "Cardiology, Whittington Hospital, London, UK",
        "Imperial College London National Heart and Lung Institute, London, UK"
      ],
      "name": "Kayla Li Xian Chiew"
    },
    {
      "affiliations": [
        "Homerton University Hospital NHS Trust, London, UK"
      ],
      "name": "Meher Lehri"
    },
    {
      "affiliations": [
        "Lister Hospital, Stevenage, UK"
      ],
      "name": "Dimitrios Palaiologos"
    },
    {
      "affiliations": [
        "Cardiology, North Middlesex University Hospital, London, UK"
      ],
      "name": "Arsalan Khalil"
    },
    {
      "affiliations": [
        "Royal Berkshire Hospital, Reading, UK"
      ],
      "name": "Brett Kennedy"
    },
    {
      "affiliations": [
        "Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, UK"
      ],
      "name": "Richard Balasubramaniam"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Cardiology, North Middlesex University Hospital, London, UK"
      ],
      "name": "Shahana Hussain"
    },
    {
      "affiliations": [
        "Dorset County Hospital NHS Foundation Trust, Dorchester, UK"
      ],
      "name": "Lauren Stanton"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Cardiology, North Middlesex University Hospital, London, UK"
      ],
      "name": "Syed Ahsan"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Christopher Primus"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Royal Berkshire Hospital, Reading, UK"
      ],
      "name": "Anthony W C Chow"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Martin Thomas"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Cardiology, North Middlesex University Hospital, London, UK"
      ],
      "name": "Amal Muthumala"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK"
      ],
      "name": "Syed M A Sohaib"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Homerton University Hospital NHS Trust, London, UK"
      ],
      "name": "Richard Ang"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Lister Hospital, Stevenage, UK"
      ],
      "name": "Nikolaos Papageorgiou"
    },
    {
      "affiliations": [
        "Dorset County Hospital NHS Foundation Trust, Dorchester, UK",
        "University Hospitals Dorset NHS Foundation Trust, Poole, UK"
      ],
      "name": "Charles Butcher"
    },
    {
      "affiliations": [
        "Cardiac Department, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Kim Rajappan"
    },
    {
      "affiliations": [
        "Queen Mary University of London, London, UK"
      ],
      "name": "Caroline Roney"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Ross J Hunter"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, UK",
        "Queen Mary University of London, London, UK"
      ],
      "name": "Shohreh Honarbakhsh"
    }
  ],
  "title": "Withdrawing guideline-directed medical therapy after left ventricular ejection fraction recovery following atrial fibrillation ablation: a multicentre cohort study",
  "uid": "eadfd1f5-37e2-5176-a79c-bcbaef7d2556"
}