Clinical Implications of Left Atrial and Ventricular Reverse Remodeling After Atrial Fibrillation Ablation in Patients With Systolic Dysfunction

Figures

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  Figure 1. Study flow. AF indicates atrial fibrillation; LVEF, left ventricular ejection fraction; MDCT, multidetector computed tomography; and PVI, pulmonary vein isolation.

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  Figure 2. MDCT reconstruction and volumetric analysis. A, Semiautomated segmentation of cardiac chambers, followed by visual inspection and manual correction performed by experienced technologists blinded to clinical data. B, Determination of end‐diastolic and end‐systolic phases based on the LV flow–volume curve reconstructed throughout the cardiac cycle. C, Automatic calculation of LA volume from the volumetric data set; the LA appendage was excluded from the analysis. D, LV volume measurement using the modified Simpson’s method (method of disks) after fine contour adjustment. ED indicates end‐diastolic; ES, end‐systolic; HR, heart rate; LA, left atrial; LV, left ventricular; and MDCT, multidetector computed tomography.

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  Figure 3. Association and classification of LARR and LVRR. The LA and LV reduction rates refer to the percentage reduction from baseline in the end‐systolic volume of the left atrium and left ventricle, respectively. LARR and LVRR were defined as ≥15% reductions, and patients were categorized into 4 groups based on the presence or absence of LARR and LVRR: LARR+/LVRR+, LARR−/LVRR+, LARR+/LVRR−, and LARR−/LVRR−. LA indicates left atrial; LARR, left atrial reverse remodeling; LV, left ventricular; and LVRR, left ventricular reverse remodeling.

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  Figure 4. Incidence of ERAA. Early recurrence of atrial arrhythmia within 3 months after ablation was compared across four reverse remodeling groups using the chi‐square test. ERAA was classified into paroxysmal intermittent ERAA and persistent ERAA lasting >7 days. Patients who experienced both types of ERAA were treated as having persistent ERAA. ERAA indicates early recurrence of atrial arrhythmia; LARR, left atrial reverse remodeling; and LVRR, left ventricular reverse remodeling.

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  Figure 5. Kaplan–Meier survival curves. Kaplan–Meier curves for (A) AF recurrence, (B) composite of HF hospitalization or cardiovascular death, and (C) all‐cause mortality. Event incidence was compared across four reverse remodeling groups using the log‐rank test. AF indicates atrial fibrillation; HF, heart failure; LARR, left atrial reverse remodeling; and LVRR, left ventricular reverse remodeling.