Reverse Remodeling of the Mitral Valve Complex After Radiofrequency Catheter Ablation for Atrial Fibrillation

Abstract

Background: Mitral regurgitation is frequently complicated with atrial fibrillation without apparent organic changes in the leaflet, which occasionally improves after successful radiofrequency catheter ablation. We aimed to evaluate a possible geometric effect of radiofrequency catheter ablation on the mitral valve apparatus. Methods: Forty-three consecutive patients who underwent successful catheter ablation for persistent atrial fibrillation (maintaining sinus rhythm for 6 months after their procedure) were examined by serial real-time 3-dimensional transesophageal echocardiography before and 6 months after catheter ablation. Mitral valve complex geometry was measured using dedicated software for 3-dimensional transesophageal echocardiography. Results: Mitral valve apparatus showed significant reverse remodeling along with left atrial reverse remodeling 6 months after successful catheter ablation (50.5 [39.2–61.0] versus 36.4 [28.9–43.1] mL/m 2 ; P <0.001). The degree of mitral regurgitation decreased in a majority of patients (mitral regurgitation jet area; 1.83 [0.78–3.09] versus 0.77 [0.36–1.47] cm 2 ; P <0.001). Annular area significantly decreased (5.32±0.91 versus 4.73±0.76 cm 2 /m 2 ; P <0.001) in both anterior-posterior and medial-lateral directions. Mitral annular contraction significantly recovered after maintaining sinus rhythm for 6 months (7.51 [4.82–9.62]% versus 9.71 [6.27–13.85]%; P =0.008). There were no significant changes in tenting volume or tenting height (0.46 [0.27–0.89] versus 0.51 [0.32–0.72] mL/m 2 , P =0.744; 2.34 [1.75–3.48] versus 2.76 [1.99–3.08] mm/m 2 , P =0.717). The leaflet surface area also significantly decreased after catheter ablation (5.74 [5.01–6.33] versus 5.19 [4.63–5.64] cm 2 /m 2 ; P <0.001). Conclusions: Maintaining sinus rhythm after successful catheter ablation promotes reverse remodeling in the mitral valve apparatus and improves so-called atrial functional mitral regurgitation. The positive geometric effect of catheter ablation would be expected to be a possible contributor to better outcomes in patients with atrial fibrillation, in addition to the postprocedural freedom from rhythm disturbance.

Association between functional mitral regurgitation and recurrence of paroxysmal atrial fibrillation following catheter ablation: a prospective cohort study

“…The positive geometric effect of catheter ablation might contribute to improved outcomes in patients with AF in addition to the post-procedural freedom from disturbance of rhythm. 27 MR increases the size of the LA and increases the incidence of AF, and the occurrence of AF increases regurgitation of the mitral valve. In patients with PAF, severe FMR is rare, most cases are mild FMR, and a few cases are moderate FMR.…”

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

“…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 .…”

“…In the past decade, catheter ablation has become an established non‐pharmacological therapy for AF. Many studies have revealed a reduction in LA enlargement after restoration of sinus rhythm by catheter ablation (reverse remodeling) 9‐20 . Reverse remodeling has also been thought to be a useful predictor for not only acute recurrence (AF recurrence ≤1 year) but also late recurrence (AF recurrence >1 year) following procedures 12‐16 .…”

Functional Mitral Regurgitation in Patients with Preserved Ejection Fraction Qualified for Pulmonary Vein Isolation: A Negative Prognostic Factor for Catheter Ablation Efficacy

“…In the study by Nishino et al [ 12 ] comprising 43 patients who underwent successful ablation for persistent AF, significant reverse remodeling of MV apparatus and LA was observed. After maintaining sinus rhythm for six months, not only did the annular area decrease (5.32 ± 0.9 vs. 4.73 ± 0.8 cm 2 /m 2 ; p < 0.001), but MA contraction also recovered (7.51% vs. 9.71%; p = 0.008).…”