TOPLINE:

In patients with atrial fibrillation (AF)-induced cardiomyopathy whose left ventricular ejection fraction (LVEF) recovered after catheter ablation, the selective withdrawal of guideline-directed medical therapy (GDMT) did not compromise LV systolic function, rhythm maintenance, or remodelling.

METHODOLOGY:

• Researchers conducted a retrospective observational study to evaluate whether withdrawing GDMT was feasible and safe for patients with AF-induced cardiomyopathy whose LVEF has recovered after catheter ablation.
• They included data from 12 UK centres for adults who underwent index AF ablation between June 2019 and 2024, with LVEF < 50% pre-ablation and recovery to ≥ 50% after ablation.
• A total of 88 patients (mean age, 61.7 years; 90.9% men) were included; of those, 50 (56.8%) continued full-dose GDMT and 38 (43.2%) withdrew ≥ 50% of GDMT classes.
• Imaging was required at three timepoints: pre-ablation, early (≥ 4 weeks post-ablation), and late (≥ 3 months after early post-ablation imaging or ≥ 3 months post-GDMT withdrawal).
• The primary outcome was mean LVEF at the late follow-up timepoint.

TAKEAWAY:

• The selective withdrawal of GDMT was not associated with lower mean LVEF at late follow‑up compared with the continued use of GDMT (56.8% vs 56.3%; P = .59), with no significant difference seen in LVEF change.
• Sinus rhythm was maintained in 92.1% of patients who withdrew GDMT and 82.0% of those who continued GDMT, with no significant difference noted between the groups. Atrial arrhythmia recurrence rates were not higher after GDMT withdrawal.
• The average LV end-diastolic diameter was not significantly different between the two groups.
• LVEF dropped below 50% in one patient in both groups owing to a non-ST elevation myocardial infarction.

IN PRACTICE:

"The study findings suggest that lifelong continuation of GDMT may not be universally required for all patients with AIC [AF-induced cardiomyopathy] who achieve sustained recovery of LV systolic function following restoration of SR [sinus rhythm] with catheter ablation," the authors wrote.

SOURCE:

This study was led by Sayed Al-Aidarous, St Bartholomew's Hospital, London, England. It was published online on October 13, 2025, in Open Heart.

LIMITATIONS:

This study was retrospective and non-randomised, with physician-driven therapy decisions. The cohort size was reduced owing to stringent imaging requirements. Methods of rhythm monitoring varied across patients.

DISCLOSURES:

This study received funding from the British Heart Foundation Clinical Intermediate Fellowship. Several authors reported receiving speaker fees, consultancy fees, grants, and fellowships and having other financial ties with various companies, including Medtronic, Biosense Webster, and Abbott. One author reported receiving a UK Research and Innovation Future Leaders Fellowship.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.