Key result
A ≥5% reduction in left atrial dimension 6 months after catheter ablation for persistent atrial fibrillation was associated with 80% freedom from late recurrence vs 42% without (HR 0.293).
Why the study?
Catheter ablation for persistent AF has an unsatisfactory success rate for unclear reasons, prompting evaluation of how post-ablation left atrial reverse remodeling relates to AF recurrence.
Is left atrial reverse remodeling associated with maintenance of sinus rhythm after catheter ablation in patients with persistent atrial fibrillation?
Case-Control (n=132)
No
Is left atrial reverse remodeling associated with maintenance of sinus rhythm after catheter ablation in patients with persistent atrial fibrillation?
Effect estimate: HR 0.293
Absolute Event Rate: 80% vs 42%
p-value: p=0.028
Left atrial reverse remodeling at 6 months post-ablation is a significant predictor of long-term freedom from atrial fibrillation recurrence in patients with persistent AF.
Left atrial reverse remodeling may aid post-ablation risk stratification in persistent AF; leaves open whether it should guide management without prospective trials.
The success rate of catheter ablation of persistent atrial fibrillation (AF) is not satisfactory, for reasons that are unclear. The purpose of this study was to examine the relationship between left atrial reverse remodeling after ablation and recurrence of AF in patients with persistent AF. One hundred and thirty-two patients with persistent AF were enrolled. Extensive encircling pulmonary vein isolation plus ablation of complex fractionated atrial electrograms was performed. Bepridil or amiodarone was prescribed for 3 months after ablation. All patients were studied by serial echocardiography and 24-h ambulatory electrocardiogram at baseline, for the day after ablation, and at 1-, 3-, and 6-month intervals after ablation. Recurrence of AF was observed in 42 patients at 2-year follow-up. The duration of AF (median 12 (IQR 6-37) vs 8 (IQR 5-17) months, p < 0.05), and early recurrence of AF (69 vs 26%, p < 0.05) after ablation were significantly different between the patients with AF recurrence and those without. The left atrial dimensions at 3 months (40 ± 6 vs 44 ± 6 mm, p < 0.001) and 6 months (40 ± 6 vs 44 ± 6 mm, p < 0.001) were significantly smaller than those just after ablation in the patients without AF recurrence. A 5% reduction from baseline in the left atrial dimension at 6 months after ablation was associated with freedom from late AF recurrence (p < 0.05). Left atrial reverse remodeling after ablation of persistent AF was associated with freedom from late recurrence of AF.
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Kagawa et al. (2019) conducted a case-control in Persistent atrial fibrillation (n=132). Catheter ablation vs. <5% reduction in left atrial dimension at 6 months was evaluated on Freedom from late recurrence of atrial fibrillation (HR 0.293, p=0.028). A ≥5% reduction in left atrial dimension 6 months after catheter ablation for persistent atrial fibrillation was associated with 80% freedom from late recurrence vs 42% without (HR 0.293).
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