{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T07:23:11Z","timestamp":1793690591955,"version":"4.5.1"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":104,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/ICRF\/22\/26034"],"award-info":[{"award-number":["FS\/ICRF\/22\/26034"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,9,24]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre cohort study across 12 UK centres included adults undergoing index AF ablation (June 2019\u2013June 2024) with LVEF &lt;50% preablation and recovery to \u226550% at three timepoints: preablation; early postablation (\u22654 weeks) and late postablation (\u22653 months or \u22653 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>88 patients met inclusion enrolment criteria (61.7\u00b110.6 years old; 91% male), of which 50 (56.8%) continued full-dose GDMT and 38 (43.2%) withdrew \u226550% of GDMT. In the GDMT-withdrawn group, mean GDMT classes decreased from 2.97\u00b10.88\u2009to 1.03\u00b10.79 (p&lt;0.001). At late follow-up, mean LVEF was comparable (56.3%\u00b13.8% GDMT-continued vs 56.8%\u00b15.5% 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&gt;0.8). SR was maintained in 82.0% vs 92.1% of patients; p=0.17.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003733","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:46:03Z","timestamp":1760352363000},"page":"e003733","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Withdrawing guideline-directed medical therapy after left ventricular ejection fraction recovery following atrial fibrillation ablation: a multicentre cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7044-9423","authenticated-orcid":false,"given":"Sayed","family":"Al-Aidarous","sequence":"first","affiliation":[{"name":"St Bartholomew\u2019s Hospital, London, UK"},{"name":"Queen Mary University of London, London, 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