Key result
Frequent premature atrial complexes (>488/day) after pulmonary vein isolation were associated with less left atrial reverse remodeling compared to lower tertiles (22.2% vs 57.1% and 59.3%, P<.001).
Why the study?
Maintenance of sinus rhythm after PVI promotes left heart reverse remodeling, but whether frequent premature atrial complexes attenuate this benefit was unknown.
Do frequent premature atrial complexes attenuate left heart reverse remodeling in patients with atrial fibrillation who maintain sinus rhythm after pulmonary vein isolation?
Cohort (n=82)
Do frequent premature atrial complexes attenuate left heart reverse remodeling in patients with atrial fibrillation who maintain sinus rhythm after pulmonary vein isolation?
Frequent premature atrial complexes after pulmonary vein isolation are associated with attenuated left atrial reverse remodeling despite the maintenance of sinus rhythm.
Frequent PACs may attenuate LA reverse remodeling after PVI despite sinus rhythm; hypothesis-generating for targeted suppression trials.
BACKGROUND: Maintenance of sinus rhythm after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with left atrial (LA) and ventricular (LV) reverse remodeling, although the degree varies among individuals. We hypothesized that frequent premature atrial complex (PAC) after PVI may attenuate the left heart reverse remodeling benefited from maintenance of sinus rhythm. METHODS: We included 82 AF patients who underwent first-time PVI and 24-h Holter recordings at 6 months after PVI. All patients had no AF recurrence before this time. The number of PAC was categorized into tertiles: <90, 90-488 and >488 PACs/day. All patients underwent two-dimensional echocardiography and serum plasma B-type natriuretic peptide (BNP) measurement before and 6 months after PVI. LA reverse remodeling was defined as ≥15% decrease in LA volume index. RESULTS: There was no significant difference in the baseline characteristics among the PAC tertiles except for sex. Six months after PVI, LA volume index, LV mass index, and serum BNP levels were significantly decreased in lower and middle PAC tertiles (all P < .05), whereas no significant changes were observed in upper PAC tertile. Frequency of LA reverse remodeling was significantly lower in upper tertile of PAC compared with middle and lower tertiles (22.2%, 57.1%, and 59.3%, P < .001). Baseline LA volume index, changes in LV mass index, and the frequency of PAC were independently associated with LA reverse remodeling (all P < .05). CONCLUSIONS: Frequent PAC after PVI was associated with less left heart reverse remodeling in AF patients even without AF recurrence.
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Hasegawa et al. (2019) conducted a cohort in Atrial fibrillation (n=82). Frequent premature atrial complexes (>488 PACs/day) vs. Lower and middle PAC tertiles (<488 PACs/day) was evaluated on Left atrial reverse remodeling (≥15% decrease in LA volume index) (p=<.001). Frequent premature atrial complexes (>488/day) after pulmonary vein isolation were associated with less left atrial reverse remodeling compared to lower tertiles (22.2% vs 57.1% and 59.3%, P<.001).
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