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

Abstract

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.

Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases

“…LA structural and functional cardiac abnormalities, including chamber dilatation and systolic/diastolic dysfunction, are all potential risk factors for AF [ 25 , 26 , 27 , 28 , 29 ]. Furthermore, LA structural and electrophysiological remodeling are key markers for risk stratification in patients with AF [ 1 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 ].…”

“…In a systematic review and meta-analysis, Njoku et al assessed whether LA volume was an independent predictor of AF recurrence following CA, and found that patients with AF recurrence following CA had a higher mean LA volume/LAVi compared with patients with no recurrence [ 31 ]. In contrast, many studies have revealed a reduction in LA enlargement after restoration of sinus rhythm by CA (reverse remodeling), and LA reverse remodeling was thought to be a marker for better outcomes (lower recurrence rate) of CA for AF [ 33 , 35 , 36 , 37 , 38 , 39 ]. In our recent work, we investigated whether the degree of LA volumetric reverse remodeling was associated with long-term outcomes (AF-free survival) after initial CA for AF in 140 patients with LA enlargement (LAVi ≥ 34 mL/m 2 ) at baseline [ 33 ].…”

“…In contrast, many studies have revealed a reduction in LA enlargement after restoration of sinus rhythm by CA (reverse remodeling), and LA reverse remodeling was thought to be a marker for better outcomes (lower recurrence rate) of CA for AF [ 33 , 35 , 36 , 37 , 38 , 39 ]. In our recent work, we investigated whether the degree of LA volumetric reverse remodeling was associated with long-term outcomes (AF-free survival) after initial CA for AF in 140 patients with LA enlargement (LAVi ≥ 34 mL/m 2 ) at baseline [ 33 ]. We found that more than half of the patients (54%) had a normal LA volume (LAVi < 34 mL/m 2 ) at 1 year follow-up after CA, and those patients had better long-term outcomes (lower recurrence rate) after CA than patients who did not have a normal LA volume.…”

The Left Atrium Is a Window to the Outcomes of Patients With Atrial Fibrillation

“…Catheter ablation can successfully eliminate the burden of AF, enabling structural reverse remodeling of the LA. 12 However, in a recent study of 140 patients with AF who underwent successful catheter ablation, it was concluded that abnormal LA pump and reservoir function persisted despite normalization of the LAVi to 34 mL/m 2 . 12 The results of this study suggested that patients with AF in whom sinus rhythm is successfully restored still have underlying substrate in the LA, and physicians should remain aware of the patient's risk for heart failure.…”

Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation

“…Therefore, numerous studies were conducted to identify the predictors of its recurrence. Most of these studies extensively focused on several LA factors, such as size [18][19][20][21][22] and function, [23][24][25][26][27] using multi-modality cardiac imaging. Generally, LA enlargement has been accepted as the most important and robust predictor of AF recurrence after ablation, and the LA diameter measured by echocardiography has been widely used due to its simplicity and universality.…”