Marco Bergonti, MD

The previous ANTWOORD I study evaluated the ANTWERP score, which predicts left ventricular ejection fraction (LVEF) recovery after ablation in patients with HF and AF, scoring patients who have one or more of the following four imaging and clinical parameters: wide QRS, known etiology, paroxysmal AF, and severe atrial dilation.

A higher score is linked with a greater likelihood of non-recovery, whereas a lower score is associated with a greater chance of recovery (AUC 0.93). A total of 605 patients with HF and impaired LVEF (<50%) who were referred for AF ablation were included in the trial. The number of responders at 1-year follow-up was the primary endpoint.

“Patients with a low score had a high percentage of LVEF recovery and those with a high score had a low percentage of LVEF recovery,” said Marco Bergonti, MD, who presented his findings at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16-18, in Barcelona, Spain^1,2.

The corresponding AUC of the ANTWERP score was 0.859 (P<0.001), and the results were consistent across the LVEF spectrum and geographical regions, according to Dr. Bergonti. “The ANTWERP score identifies patients with HF who would benefit the most from AF ablation,” he said. Patients with a score greater than 3 are estimated to have LVEF recovery in more than 90% of the cases and are strong candidates for receiving an early AF ablation. However, patients with a score greater than 4 have a limited chance of responding (<20%) and clinicians should look for alternative treatment strategies. The recovery likelihood of patients with a score of 3 or 4 is approximately 50%. For these patients, further assessment is necessary to determine which treatment strategy is best, Dr. Bergonti said.

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