Lower CT-derived left ventricular extracellular volume was independently associated with reverse remodeling after atrial fibrillation ablation (OR 0.84; 95% CI 0.75-0.95; p=0.006).
Cohort (n=102)
Does CT-derived left ventricular extracellular volume predict reverse remodeling after catheter ablation in patients with atrial fibrillation and reduced LVEF?
CT-derived left ventricular extracellular volume fraction is an independent predictor of reverse remodeling after atrial fibrillation ablation in patients with reduced LVEF, which may help distinguish tachycardia-induced cardiomyopathy from underlying myocardial disease.
Effect estimate: OR 0.84 (95% CI 0.75-0.95)
p-value: p=0.006
Left ventricular (LV) extracellular volume fraction (ECV) quantified by cardiac computed tomography (CT) reflects diffuse myocardial fibrosis. In patients with atrial fibrillation (AF) and reduced LV ejection fraction (LVEF), distinguishing tachycardia-induced cardiomyopathy from underlying myocardial disease remains challenging. The prognostic value of ECV for predicting reverse remodeling (RR) after catheter ablation for AF remains uncertain. We retrospectively analyzed 102 patients with LVEF ≤ 50% on echocardiography who underwent cardiac CT before AF ablation between May 2015 and April 2025. RR was defined as a ≥15% reduction in LV end-systolic volume with recovery of LVEF > 50%, or an absolute increase in LVEF of ≥15%. RR occurred in 49 patients (48%). ECV was significantly lower in patients with RR than in those without (31.2 ± 3.5% vs. 37.6 ± 7.8%, p < 0.001). Receiver operating characteristic analysis identified an optimal cutoff of 34.8% (area under the curve 0.77; sensitivity 88%; specificity 62%, p < 0.001). In multivariable logistic regression analysis, lower ECV remained independently associated with RR (odds ratio 0.84; 95% confidence interval 0.75–0.95; p = 0.006). CT-derived ECV was associated with RR after AF ablation in patients with reduced LVEF and may provide additional information for clinical decision-making.
Kinoshita et al. (Thu,) conducted a cohort in Atrial fibrillation with reduced LV ejection fraction (n=102). Computed Tomography-Derived Left Ventricular Extracellular Volume (ECV) was evaluated on Reverse remodeling defined as a ≥15% reduction in LV end-systolic volume with recovery of LVEF > 50%, or an absolute increase in LVEF of ≥15% (OR 0.84, 95% CI 0.75-0.95, p=0.006). Lower CT-derived left ventricular extracellular volume was independently associated with reverse remodeling after atrial fibrillation ablation (OR 0.84; 95% CI 0.75-0.95; p=0.006).