Key result
Repeat AF ablation is linked to reverse LA remodeling in ~22%, predicted by larger baseline LAVI.
Why the study?
Atrial tachycardias remain a key issue after catheter ablation for atrial fibrillation, alongside left atrial remodeling as an important consequence.
What are the predictors of reverse structural left atrial remodeling and atrial tachycardia recurrence in patients undergoing repeat ablation for atrial fibrillation?
Observational (n=113)
What are the predictors of reverse structural left atrial remodeling and atrial tachycardia recurrence in patients undergoing repeat ablation for atrial fibrillation?
Effect estimate: HR 1.03 (95% CI 1.00-1.07)
p-value: p=0.036
In patients undergoing repeat AF ablation, larger initial LA volume index predicts reverse structural remodeling, while female gender, larger LAVI, and greater LA scar area predict atrial tachycardia recurrence.
Larger baseline LAVI may identify remodeling candidates after repeat ablation; hypothesis-generating and requires prospective validation before guiding practice.
BACKGROUND: Catheter ablation has been evolved to a cornerstone in the therapy of atrial fibrillation (AF); however, atrial tachycardias (AT) after AF ablation are still an important issue. Besides the electrical recurrence of atrial tachyarrhythmia after ablation, left atrial (LA) remodeling has received attention as a consequence of AF. OBJECTIVE: The aim of this study is to evaluate predictors for AT recurrence and LA remodeling in patients with repeat AF ablation procedures. METHODS AND RESULTS: One hundred thirteen patients who underwent repeat AF ablation with 3D electro-anatomical mapping system were evaluated. Mean age was 63.1 ± 9.3 years, and 2.3 ± 0.5 ablation procedures were performed during a time period of 22 [IQR 7;48] months. Reverse structural LA remodeling (LA volume decreased more than 15%) was observed in 25 (22.1%) patients. LA volume index (LAVI) during first procedure was the only predictor for positive reverse structural LA remodeling (hazard ratio (HR): 1.03, 95% CI: 1.00-1.07, p = .036) in multivariate analysis. Fifty-nine (52.2%) patients experienced only AF and 54 (47.8%) patients AT after first procedure. Female gender (HR: 5.21, 95% CI: 1.66-18.08, p = .006), LAVI (HR: 1.06, 95% CI: 1.02-1.11, p = .008) and LA scar percentage (HR: 1.08, 95% CI: 1.02-1.17, p = .019) were independent significant predictors for AT recurrence in multivariate analysis. CONCLUSIONS: Reverse structural LA remodeling occurred in a quarter of patients with repeat ablation procedures for AF. Only larger LAVI during first procedure predicted reverse structural LA remodeling. Half of the patients experienced AT between first and last ablation procedure. Female gender, larger LAVI and larger scar area were significant predictors for AT after catheter ablation for AF.
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Hashiguchi et al. (2022) conducted an observational in Atrial fibrillation (n=113). Repeat catheter ablation was evaluated on Reverse structural left atrial remodeling (LA volume decreased >15%) (HR 1.03, 95% CI 1.00-1.07, p=0.036). In patients undergoing repeat AF ablation, reverse structural LA remodeling occurred in 22.1%, predicted by larger baseline LAVI, while female gender, LAVI, and scar area predicted AT recurrence.
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