Assessment of left atrial hemodynamics and myopathy markers in patients undergoing repeat catheter ablation for atrial fibrillation

Introduction Atrial fibrillation (AF) leads to left atrial (LA) remodelling, elevated pressure, and reduced compliance, promoting symptoms and adverse outcomes, particularly during exercise. Catheter ablation may induce reverse remodelling and improve LA function but can also worsen compliance, especially in patients with underlying atrial disease. Purpose This study aimed to comprehensively assess changes in LA hemodynamics and markers of LA myopathy in patients undergoing repeat catheter ablation for AF due to arrhythmia recurrence. Methods Twenty-six adults with symptomatic paroxysmal or persistent AF, referred for repeat ablation, underwent standardized non-invasive assessment including echocardiography, NT-proBNP biomarker, and symptom inventories. Invasive LA haemodynamics were measured at the time of the ablation procedure. Results Patients (mean age 68 years, predominantly male) maintained preserved ventricular function. Prior to repeat ablation, non-invasive assessment showed improvement in LV diastolic parameters, reductions in NT-proBNP and AF symptom frequency. Invasive measurements showed a significant reduction in end-atrial diastolic pressure but a rise in LA pulse pressure. Peak LA pressure exhibited a clear time-dependent pattern, with earlier repeat procedures showed neutral or lower pressures, whereas longer intervals were associated with progressively higher peak LA pressures. Conclusion Repeat AF ablation yields some symptomatic and hemodynamic improvement but is associated with progressive adverse LA remodelling over time, particularly for patients with comorbidities.