Reverse remodelling of the heart after atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

Abstract

Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freedom from AF and left heart reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF).Methods. There were 47 patients (mean age 53.3 ± 10 years, 39 males) enrolled into single-center observational study, with left ventricular ejection fraction (LVEF) <40 %. Patients underwent CA for AF refractory to antiarrhythmic drugs. Baseline clinical data and diagnostic tests results were obtained during personal visits and / or via secure telemedical services. Personal contact with evaluation of recurrence of AF and echocardiographic values was performed with 30 (64 %) patients.Results. Paroxysmal AF was present in 12 (40 %) patients, persistent – in 18 (60 %). During mean follow-up of 3 years (0.5–6 years) redo ablation was performed in 9 patients (30 %) with average number of 1.3 procedures per patient. At 6 months 24 (80 %) patients were free from AF, at last follow-up – 16 (53 %). The mean time to first recurrence following CA was 15.6±13.3 months. Follow-up echocardiography revealed significant LVEF improvement (р<0,0001), reduction of left atrium size (р<0,0001), left ventricle end-diastolic volume (р<0,002) and left ventricle endsystolic volume (p<0,0001) and mitral regurgitation (р=0,001).Conclusion. AF CA in patients with HFrEF is associated with improvement in systolic function and left heart reverse remodeling. Durable long-term antiarrhythmic effect often requires repeated procedures.

Factors associated with the efficacy of atrial fibrillation radiofrequency catheter ablation: opinion of the specialists who use the “Ablation Index” module

“…8). Thus, the need for AF CA in Russia is comparable to world data [6], with a greater need for patients with persistent AF.…”

“…Antiarrhythmic drug (AAD) therapy for rhythm control strategy and AF recurrences prevention is often limited, associated with side effects, and ineffective. But AF catheter ablation (CA) is associated with long-term maintenance of sinus rhythm, improvement of quality of life, as well as fewer hospitalization and mortality rate due to HF according to randomized and non-randomized multicenter studies [3][4][5][6].…”

“…However, these figures are still far from the true need for AF catheter treatment [7]. Although, 10-20% of CA are redo procedures due to AF recurrent [6,8].…”

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation

“…Growing evidence suggests that AF is a kind of progressive disease that is not only a result of structural, electrophysiological and haemodynamic remodeling but also a cause of these processes described above 10,14,15 . Restoration of sinus rhythm by successful ablative treatment in patients suffering from AF causes reverse left atrial remodeling 16,17 . AER, which was outlined by Wijffels et al in 1995 as an important component of reversal, can affect the prognosis of AF.…”