Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation

Kagawa, Yoshihiko; Fujii, Eitaro; Fujita, Satoshi; M, Ito

doi:10.1007/s00380-019-01475-1

Cited by 29 publications

(24 citation statements)

References 23 publications

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“…For example, the left atrial dimensions at three months (44 ± 6 versus 40 ± 6 mm, p < 0.001) and six months (44 ± 6 versus 40 ± 6 mm, p < 0.001) were significantly smaller compared with just after ablation in the patients without AF recurrence. Additionally, the authors found a significant decrease of the natriuretic peptide concentrations between baseline levels and those at three and six months (111.0 versus 34.9 pg/mL, p < 0.001; 111.0 versus 30.4 pg/mL, p < 0.001), thus furtherly confirming the potential benefits of catheter ablation not just for AF management, but also for the outcome of patients with ACM and HF [ 71 ].…”

Section: Particular Therapeutic Approachesmentioning

confidence: 84%

Latest Insights into Mechanisms behind Atrial Cardiomyopathy: It Is Not always about Ventricular Function

et al. 2021

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Atrial cardiomyopathy (ACM) represents a constantly evolving concept, with increasing importance in contemporary research and clinical practice. A better understanding of the mechanisms involved in atrial remodeling and its clinical correlations especially with atrial fibrillation (AF) and other cardiometabolic comorbidities may induce a significant impact on the diagnosis, prognosis, and therapeutic approach of ACM-related comorbidities. Although initially described several decades ago, investigators have only recently highlighted that several renal, metabolic, and cardiovascular diseases are determining factors for atrial remodeling and subsequent ACM. Based on data from multiple recent studies, our research emphasizes the correlations between ACM and other coexisting pathologies including cardiovascular, respiratory, or metabolic diseases, with fibrosis being the most incriminated pathophysiological mechanism. In addition to the usual tests, the paraclinical assessment of ACM is increasingly based on the use of various cardiac biomarkers, while the cardiac magnetic resonance (CMR) has become an increasingly tempting diagnostic too for describing morphofunctional aspects of the heart chambers, with the gadolinium contrast enhanced CMR (LGE-CMR) emerging as a commonly used technique aiming to identify and quantify the precise extent of atrial fibrosis. Further research should be conducted in order to clarify our knowledge regarding atrial remodeling and, therefore, to develop new and improved therapeutic approaches in these patients.

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Section: Particular Therapeutic Approachesmentioning

confidence: 84%

Latest Insights into Mechanisms behind Atrial Cardiomyopathy: It Is Not always about Ventricular Function

et al. 2021

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“…Since the establishment of PVI due to advances in catheter technologies and techniques, numerous studies have demonstrated LA reverse remodeling due to restoration and maintenance of sinus rhythm after PVI 9‐20, 27‐31 . Regarding LA structural reverse remodeling, meta‐analyses revealed that LA diameter and LA volume were significantly decreased by AF ablation 18, 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Since the establishment of PVI due to advances in catheter technologies and techniques, numerous studies have demonstrated LA reverse remodeling due to restoration and maintenance of sinus rhythm after PVI. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 27 , 28 , 29 , 30 , 31 Regarding LA structural reverse remodeling, meta‐analyses revealed that LA diameter and LA volume were significantly decreased by AF ablation. 18 , 19 On the other hand, although the LA function was also improved by successful RFCA, several studies have reported persistent LA functional abnormalities after effective ablation.…”

Section: Discussionmentioning

confidence: 99%

Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation

Kawakami

Inoue

Nagai

et al. 2021

Journal of Arrhythmia

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Background Left atrial volume index (LAVI) of >34 mL/m2 is the cutoff value for identifying an enlarged left atrium. The definition of left atrial (LA) reverse remodeling after atrial fibrillation (AF) ablation is undetermined. We hypothesized that patients with LA dilatation who achieve normal LA volume (LAVI<34 mL/m2) after AF ablation have better long‐term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume can also achieve normal LA function with AF ablation. Methods We enrolled 140 AF patients with baseline LAVI of ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle‐tracking echocardiographic parameters within 24 hour and at 1 year after the procedure. To define the normal range of LA function, age‐ and sex‐matched controls without a history of AF were also enrolled. Results After restoration of sinus rhythm, LA structural and functional parameters significantly improved, and 75 patients (54%) had normal LA volume. During a median follow‐up of 44 (31‐61) months, 32 patients (23%) experienced a late recurrence of AF (AF recurrence >1 year). Patients who achieved normal LA volume after AF ablation had fewer late recurrences than those who did not (P < .01). However, LA abnormalities, especially LA dysfunction, persisted in AF patients even when the LA volume was normalized compared with controls. Conclusion Patients who achieved normal LA volume had better long‐term outcomes of AF ablation than those who did not; however, LA abnormalities persisted even after successful ablation of AF.

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“…LAD reduction was calculated as (LAD during index hospitalization-LAD at follow-up echocardiography)/ LAD during index hospitalization × 100 (%). LA reverse remodeling was defined as LAD reduction ≥ 5% at follow-up echocardiography 18 . Patients were classified according to LVEF at index hospitalization (HFpEF: LVEF ≥ 50%, HFmrEF: LVEF 40%–49% and HFrEF: LVEF < 40%).…”

Section: Methodsmentioning

confidence: 99%

Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction

Shiba

Kato

Morimoto

et al. 2022

Sci Rep

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We aimed to investigate the relationship between left atrial (LA) reverse remodeling and prognosis of heart failure (HF) with recovered ejection fraction (EF) (HFrecEF). Among 1,246 patients with acute heart failure enrolled in the prospective longitudinal follow-up study, 397 patients with HF with mildly-reduced EF and with reduced EF at discharge were analyzed. Echocardiography was performed during the index hospitalization and at the 6-month follow-up after discharge. They were divided into non-HFrecEF (n = 227) and HFrecEF (n = 170) groups. The primary outcome measure was a composite of all-cause death or hospitalization for HF. The cumulative 180-day incidence of the primary outcome measure after follow-up echocardiography was significantly lower in the HFrecEF group than in the non-HFrecEF group (8.9% versus 23.4%, log-rank P = 0.0002). LA reverse remodeling was associated with a lower cumulative 6-month incidence of the primary outcome measure in the HFrecEF group (4.7% versus 18.0%; HR: 0.27, 95%CI: 0.09–0.79, P = 0.01), but not in the non-HFrecEF group (24.4% versus 22.6%; HR: 1.13, 95%CI: 0.65–1.96, P = 0.28) with a significant LA reverse remodeling-by-HFrecEF interaction (P for interaction = 0.02). Combination of left ventricular and atrial reverse remodeling may help in improving HF risk stratification.

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Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation

Cited by 29 publications

References 23 publications

Latest Insights into Mechanisms behind Atrial Cardiomyopathy: It Is Not always about Ventricular Function

Latest Insights into Mechanisms behind Atrial Cardiomyopathy: It Is Not always about Ventricular Function

Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation

Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction

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