June 7, 2025The American Journal of CardiologyOpen Access

Remodeling and Reverse-Remodeling of Left Atrium and Appendage After Catheter Ablation for Atrial Fibrillation

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Why the study?

Does catheter ablation for atrial fibrillation improve left atrial and appendage remodeling parameters in patients with AF?

Structured PICO

Does catheter ablation for atrial fibrillation improve left atrial and appendage remodeling parameters in patients with AF?

Population

372 consecutive patients with atrial fibrillation undergoing catheter ablation with pre- and post-procedure contrast CT images. Mean age 70 years, CHA2DS2-VASc score 2.5±1.7.

Intervention

Catheter ablation for atrial fibrillation (pulmonary vein isolation alone or with additional ablation)

Outcome

Changes in left atrial volume (LAV), left atrial emptying fraction (LAEF), left atrial appendage volume (LAAV), and left atrial appendage emptying fraction (LAAEF) on follow-up CT, and recurrence of atrial tachyarrhythmiassurrogate

Catheter ablation for atrial fibrillation induces significant reverse-remodeling of the left atrium and appendage, particularly in patients with non-paroxysmal AF without recurrence, whereas LA emptying fraction may decrease in paroxysmal AF patients receiving extensive ablation.

Implication

CT-based LA/LAA remodeling assessment post-AF ablation should not yet alter management; leaves open its prognostic value.

Abstract

Background The processes of remodeling and reverse-remodeling of left atrial (LA) and LA appendage (LAA) after catheter ablation for atrial fibrillation (AF) are insufficiently evaluated. Methods A total of 372 consecutive AF patients undergoing ablation procedure with contrast CT images and whose follow-up CT images were acquired after the procedure were enrolled. From those CT images, LA volume (LAV), LA emptying fraction (LAEF), LAA volume (LAAV), and LAAEF were measured. Results Mean age of patients was 70 years, and CHA2DS2-VASc score was 2.5±1.7. Mean LAV, LAEF, LAAV, and LAAEF were 121.3 ml, 22.1%, 18.6 ml, and 23.5%, respectively. For patients with LA and LAA remodeling, non-paroxysmal AF (non-PAF) was more prevalent and strongly correlated with heart failure-related parameters. All types of remodeling were associated with recurrent post-procedure atrial tachyarrhythmias, and LAV emerged as an independent risk factor for recurrent tachyarrhythmias (adjusted hazard ratio 1.01, P=0.02) in multivariable analysis. Follow-up CT images showed that LAV and LAAV significantly decreased, while LAEF and LAAEF significantly increased accompanied by a reduction in filling defects in the LAA. After the procedure, reverse-remodeling was prominent in non-PAF patients, while LAEF significantly decreased in PAF patients. The decrease in LAEF for PAF patients was significantly larger in those who received additional ablation beyond pulmonary vein isolation (PVI) than those who received PVI alone. On the other hand, in non-PAF patients, post-procedure LA reverse-remodeling was consistent regardless of ablation strategy, but significantly poor in those with recurrence. Conclusions LA and LAA remodeling were more prevalent in non-PAF patients. LA and LAA reverse-remodeling after the ablation procedure were remarkable in non-PAF patients, especially those without recurrence. Meanwhile, LAEF decreased after the procedure in PAF patients, particularly in those who received additional ablation beyond PVI.