Abstract 13747: Investigation of the Probability of Spontaneous Conversion From Atrial Fibrillation to Sinus Rhythm Utilizing Continuous Rhythm Monitoring

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Paul D Ziegler ◽  
Efstratios I Charitos
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Time Course ◽  
Hierarchical Regression ◽  
Related Factors ◽  
Blue Line ◽  
Spontaneous Conversion ◽  
Af Recurrence ◽  
Red Line

Introduction: Atrial fibrillation (AF) recurrence or spontaneous conversion to sinus rhythm (SR) are regarded as random events. Hypothesis: We hypothesized that the probability of spontaneous conversion to SR decreases as more time is spent in AF. We attempt to quantify this phenomenon and investigate factors that can affect this probability. Methods: Cardiac rhythm histories of 1195 patients (age 73.0 ± 10.1, follow-up: 349 ± 40 days; 14533 AF episodes) with implantable devices were reconstructed and analyzed. No patients received cardioversion, AF ablation, or any obvious AF therapies during follow-up. Patients with no AF recurrence or continuous AF during follow up were excluded. Hierarchical regression methods were employed to investigate the time course of the probability of rhythm change and factors that influence it. Results: Probabilities of spontaneous conversion from AF to SR (solid blue line) and recurrence of AF in patients with SR (solid red line) are shown in the Figure. For patients in AF , spontaneous conversion probability significantly decreases with time spent in AF and plateaus after ~7 days (dotted blue line). Similarly for patients in SR, increasing time in SR reduces the probability of developing AF (solid red line) and plateaus after ~7 days (dotted red line). Patient age (p<0.001), LVEF (p<0.05) and presence of coronary artery disease (p<0.01) significantly influence the spontaneous conversion probabilities independent from AF burden. Conclusions: Spontaneous SR conversion or AF recurrence diminishes with increasing time spent in AF or SR, respectively, and are influenced by several patient-related factors. These findings suggest that patients should be closely monitored after AF recurrence or SR conversion.

scholarly journals Atrial fibrillation recurrence after transcatheter ablation worsens left atrial strain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Annunziata ◽  
F Notaristefano ◽  
L Spighi ◽  
S Piraccini ◽  
G Giuffre' ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Atrial Strain ◽  
Af Recurrence

Abstract Introduction Left atrial strain (LAs) shows correlation with atrial fibrosis and is a predictor of atrial fibrillation (AF) recurrence after transcatheter ablation. Little is known about LAs evolution after ablation. Purpose We sought to evaluate the atrial function with echocardiographic strain before and 6 months after AF ablation. Methods 65 consecutive patients undergoing radiofrequency or cryoballoon ablation for atrial fibrillation at our centre were enrolled. They underwent a transthoracic echocardiography before the procedure and at 6 months follow-up. 5 patients were excluded because of low quality images. Global left atrial strain during the reservoir phase (LASr) was calculated as a mean of the values obtained in 4 and 2 chamber apical view; the ventricular end-diastole was set as reference to allow the calculation both in patients in AF and sinus rhythm during the echocardiography. Recurrence was defined as any atrial arrhythmia episode lasting more than 30 seconds recorded on an EKG strip after the 3 months blanking period; all patients underwent a 24 hours EKG Holter after the blanking period to detect asymptomatic recurrence. Quality of life was assessed before the procedure and at follow-up with the EQ-5D-3L model. Results At 6 months 14 patients (13%) had AF recurrence. Patients with recurrence (AF-R) had similar baseline characteristics compared to those without recurrence (AF-NR) but the former had a longer history of AF (39±53 vs 85±94 months, p=0,018). LASr, LA volume and left ventricle ejection fraction (EF) were similar at baseline between groups. At follow-up LASr was significantly impaired in the AF-R group compared to AF-NR (14±6% vs 26±10% respectively, p&lt;0,0001) whereas LA volume, LV end systolic volume and EF remained similar. Compared to baseline LASr worsened in patients experiencing AF recurrence (22±11% vs 14±6%, p=0.016) and this finding was consistent also in patients in sinus rhythm during both examinations (29±8 vs 17±7, p=0,005). Compared to baseline LASr (22±10% vs 26±10%, p=0.024), LV end-systolic volume (29±15 ml vs 22±6 ml, p=0,006) and EF (51±9% vs 58±18%, p=0,038) improved in the AF-NR group but the effect was driven mainly by patients restoring sinus rhythm. Both groups showed a significant improvement of the quality of life (55±23 vs 85±13, p&lt;0,0001 AF-NR; 63±17 vs 80±12, p=0,012 AF-R). Conclusions Atrial fibrillation recurrence after transcatheter ablation is associated with significant left atrial strain worsening which indicates disease progression and may predispose to further long-term recurrences whereas a successful ablation has a protective effect on atrial function. Funding Acknowledgement Type of funding source: None

scholarly journals Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
E Stefanidis ◽  
K Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Course ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
Functional Changes ◽  
Af Recurrence

Abstract Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value &lt;0.05 (baseline vs. follow-up). Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

scholarly journals Catheter, surgical, or hybrid procedure: what future for atrial fibrillation ablation?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Giuseppe Nasso ◽  
Roberto Lorusso ◽  
Marco Moscarelli ◽  
Giuseppe De Martino ◽  
Angelo M. Dell’Aquila ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Hybrid Approach ◽  
Left Ventricular ◽  
Hybrid Procedure ◽  
Epicardial Ablation ◽  
Af Ablation ◽  
Linear Lesions ◽  
Af Recurrence

Abstract Background The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established. Methods From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann’s bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. Results The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence. Conclusions Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.

scholarly journals Total NT-proBNP, a novel biomarker in atrial fibrillation. A mechanistic analysis of the GISSI-AF trial

2020 ◽  
Author(s):  
Lidia Staszewsky ◽  
Jennifer Meessen ◽  
Deborah Novelli ◽  
Ulla Wienhues-Thelen ◽  
Marcello Disertori ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Sinus Rhythm ◽  
Myocardial Injury ◽  
The Novel ◽  
Circulating Biomarkers ◽  
History Of ◽  
One Year ◽  
Af Recurrence

AbstractObjective(1) to test the association with prevalent and incident atrial fibrillation (AF), and prognosis of total N-terminal pro-B type natriuretic peptide (total NT-proBNP) and of a panel of biomarkers; (2) to assess iwhether the extent of glycosylation affects the relation of NT-proBNP with AF.MethodsIn a sub-study of the GISSI-AF trial on 382 patients in sinus rhythm with a history of AF, echocardiographic variables and eight circulating biomarkers were serially assayed over one year. The relations between circulating baseline biomarkers and AF and the risk of CV events, were assessed by Cox-analysis models adjusting the first by clinical variables, the second by clinical variables and the echocardiographic left-atrial-minimum-volume-index (LAVImin).ResultsOver a median follow-up of 365 days, 203/382 patients (53.1%) had at least one recurrence of AF and 16.3% were hospitalized for cardiovascular (CV) reasons. Total NT-proBNP, NT-proBNP, angiopoietin 2 (Ang2), myosin binding protein (MyBPC3) and bone morphogenic protein-10 (BMP-10) were strongly associated to ongoing AF. Natriuretic peptides and MyBPC3 predicted recurrent AF but this lost significance after adjustment for LAVImin. NT-proBNP and Ang2 predicted CV hospitalization even after adjustment for LAVImin, HR95%CI: 2.20 [1.02-4.80] and 5.26 [1.16-23.79].ConclusionsThe association of AF recurrence with the novel biomarker total NT-proBNP, is similar to that of NT-proBNP, suggesting no influence of glycosylation. Ang2, MyBPC3 and BMP10 were strongly associated with AF, indicating a possible role of extracellular matrix and myocardial injury. Abstract-words=233Key messagesWhat is already known on this subject?It is still complicated to predict the recurrence of AF in patients in sinus rhythm with a recent history of AF. Though several biomarkers have been associated with AF, few of them have proved to be independent predictors for recurrent AF or cardiovascular (CV) events. Their predictive sensitivity and specificity is modest at best. Previous studies showed that NT-proBNP was possibly the strongest predictor of recurrent AF and CV hospitalization. Natriuretic peptides circulate to a large extent as glycosylated molecules and a novel assay is now available to measure the glycosylated and non-glycosylated NT-proBNP in plasma, the total NT-proBNP. The extent of glycosylation varies in different diseases.What might this study add?No studies have assessed (a) the extent of NT-proBNP glycosylation in AF, or (b) the association and predictive value in patients with AF of total NT-proBNP. A multimarker approach, ratter than one based on a single biomarker, might predict AF better.The relation with AF of the novel biomarker, total NT-proBNP, is as strong as that of NT-proBNP, suggesting no-influence of glycosylation.Two biomarkers, MyBPC3, secreted few minutes after myocardial injury and Ang-2, involved in inflammation and coagulation, were strongly associated to AF.How might this impact on clinical practice?The identification of novel circulating biomarkers could have a direct impact on clinical practice when predicting the occurrence of AF, but unfortunately current data do not allow predictions based on biomarkers.The associations of different biomarkers with ongoing AF may cast light on the mechanisms of triggering and maintenance of AF.Strengths and limitations of this studyThe data came from to a multicenter randomized clinical trial with available concomitant serial echocardiographic and circulating biomarkers recorded and evaluated centrally, hence with minimal bias; AF recurrence during a 12-month follow up was checked weekly by trans-telephonic electrocardiographic monitoring, and with 12-lead ECG every six months.A comparative analysis of total NT-proBNP with other novel biomarkers and echocardiographic variables has never been done so far. The possible added value of total NT-proBNP to the benchmark biomarker NT-proBNP was assessed on the basis of different dimensions of performance, as recently proposed for new biomarkers. The main limitations are (1) the relatively small numbers of patients with AF during follow-up visits, (2) the very low prevalence of patients with other cardiac diseases such as coronary artery disease and heart failure, and (3) consequently, the low incidence of clinical events in one-year follow-up.

scholarly journals Non-valvular atrial fibrillation recurrence after sinus rhythm restoring at different follow-up periods: phenotype-genotype high-risk groups, considering rs10465885 polymorphism in connexin-40 gene

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Mikhalieva ◽  
O Sychov ◽  
T Getman ◽  
Y Zinchenko ◽  
A Borodai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Stratification ◽  
Sinus Rhythm ◽  
Risk Groups ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Connexin 40 ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Purpose to provide risk stratification of non-valvular atrial fibrillation (AF) recurrence after sinus rhythm restoring (SRR) in patients (pts) with AF at different follow-up periods (3 months (AFr3m), 12 months (AFr12m) and 18 months [AFr18m]), based on phenotype-genotype high-risk groups, considering rs10465885 polymorphism in connexin-40 gene (SNP-Cx40). Methods. We enrolled 186 pts (mean age (55 ± 10) years; males 123 [66,1%]) with AF (paroxysmal – 86, persistent – 72, stable – 28 pts; first onset (FO) AF – 48 pts). Clinical, laboratory and echocardiographic data were analyzed. SNP-Cx40 was genotyped by real time PCR (T – reference, C – minor allele) in 112 pts. The genotypes were distributed as follows: TT – 25,9% (n = 29); CT – 49,1% (n = 55); CC – 25,0% (n = 28). SRR was performed in 112 cases (102 pts) with non-permanent AF: 30 – pharmacological cardioversion (PCV), 62 – direct-current cardioversion (DCV), 20 cases – radiofrequency ablation (RFA). AFr3m occurred in 53 (43,4%) of 122 available cases; AFr12m – 65,5% (76/116); AFr18m – 75,2% (79/105). The Artificial Neural networks (ANNs) analysis was performed to select the AF recurrence predictors. We considered the ANN activation function value (Y) and its relation to Y cut-off value (Ycrit). In case of Y &gt; Ycrit, the AF recurrence risk was considered as «high». Results. We built three nonlinear ANN models (multilayer perceptrons) for AFr3m (Ycrit = 0,496), AFr12m (Ycrit = 0,503) and AFr18m (Ycrit = 0,720) risk prediction. In case of SNP-Cx40 CC genotype carriage, we determined the additional increase of AFr3m risk after PCV in pts with CHA2DS2-VASc score «0» and normal (Y = 0,629) or mildly decreased (Y = 0,616) left ventricular mid-wall fractional shortening, and in the case of its moderate decrease – both after PCV (Y = 0,585) and DCV (Y = 0,627). The CC genotype was associated with AFr12m high risk in pts without heart failure (HF) and mildly increased left atrial dimension (LAD) – both after PCV (FO AF with known precise event duration (PED); Y = 0,906) or DCV (FO AF with unknown PED; Y = 0,911). Additionally, CC genotype was associated with AFr12m high risk after RFA in pts without HF and normal or mildly increased LAD (Y = 0,912), and in pts with HF B or C1 stage (according to modified AHA/ACC classification) with moderately increased LAD (Y = 0,912). The high-risk groups of AFr18m in pts with CC genotype were as follows (Y = 0,913): after RFA in pts with recurrent AF and presence of episodes lasting ≥7 days; after PCA in case of FO AF with unknown PED and index episode lasting ≥1 month; after DCV in case of FO AF with unknown PED and index episode lasting ≥12 months. Conclusion. AFr3m, AFr12m and AFr18m, besides SNP-Cx40, were non-linearly associated with SRR type, and certain clinical and echocardiographic phenotypic parameters, which could be used for AF recurrence risk stratification, with the selection of phenotype-genotype high-risk groups, considering SNP-Cx40.

scholarly journals Early assessment of left atrial function after cardioversion predicts recurrence of atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Kupczynska ◽  
BW Michalski ◽  
E Trzos ◽  
D Miskowiec ◽  
L Szyda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Early Assessment ◽  
Ventricular Ejection Fraction ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background The restoration of sinus rhythm (SR) improves the mechanical function of the heart. Purpose To assess left atrial (LA) function before and within 24 hours after successful electrical cardioversion (EC) and its prognostic value for atrial fibrillation (AF) recurrence during 24 months follow-up. Methods Prospective study involved 71 patients with non-valvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echocardiography before and after EC. We analysed standard parameters in two-dimensional echo, pulse-wave Doppler and tissue Doppler echocardiography. Using speckle-tracking method we assessed peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). Results During follow-up we noticed AF recurrence in 48 (68%) patients. Median time to AF recurrence was 2.4 (IQR 1 to 6.9) months. Left ventricular ejection fraction as well as E/E’ and PALS assessed during AF were statistically insignificant as potential predictors in univariate regression model. Receiver operating characteristic curve analysis revealed that left atrial volume index &gt;37 ml/m² (AUC = 0.811, p &lt; 0.0001), E/A ratio &gt;2.1 (AUC = 0.828, p &lt; 0.0001), A wave ≤0.4 m/s (AUC = 0.662, p = 0.01), mean E/E’ ratio during sinus rhythm &gt;8.5 (AUC = 0.815, p &lt; 0.0001), mean A’ wave of ≤5.5 cm/s (AUC = 0.848, p &lt; 0.0001), PALS-SR ≤14.1% (AUC = 0.767, p &lt; 0.0001), PACS ≤4.3% (AUC = 0.883, p &lt; 0.0001) were the optimal cut-off values for predicting AF recurrence. Conclusions The assessment of LA and diastolic function conducted within 24 hours after successful cardioversion predicts long-term maintenance of sinus rhythm.

scholarly journals Signs of heart failure with preserved ejection fraction in atrial fibrillation patients normalise in many patients after restoration of sinus rhythm

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M.C.P Wagemakers ◽  
R Wesselink ◽  
J Neefs ◽  
A Kougioumtzoglou ◽  
N.W.E Van Den Berg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Diastolic Dysfunction ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Af Ablation ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) coexist in many patients. AF and HFpEF are closely intertwined, but there are important knowledge gaps in the pathogenesis, risk, prevention and treatment of AF with concomitant HFpEF, in particular with respect to reversal of HFpEF signs. Purpose To assess the proportion of AF patients with (any) HFpEF criteria (including patients with heart failure with moderately reduced ejection fraction (HFmrEF)) who – after successful AF ablation – no longer meet the criteria for HFpEF on neurohumoral and echocardiographic level. Furthermore, to assess whether normalisation of HFpEF criteria positively affects AF recurrence. Methods Patients (n=526) underwent thoracoscopic AF ablation, consisting of pulmonary vein isolation (PVI) alone or PVI with additional lines in the case of persistent AF and were prospectively followed-up. Patients (n=338) with a left ventricular ejection fraction (LVEF) ≥40% and a successful ablation at 6 months follow-up, that is freedom of AF, or any atrial tachycardia of more than 30 seconds, were included in this study. Participants were grouped based on N-terminal pro-b type natriuretic peptide (NT-proBNP) into those with a NT-proBNP &lt;125pg/ml, defined as control patients (group 1), and those with a NT-proBNP level ≥125pg/ml, defined as HFpEF patients (group 2). HFpEF patients were further classified in different degrees of HFpEF severity, based on the number of diagnostic echocardiographic criteria for diastolic dysfunction present into possible HFpEF (group 2a, &lt;2 criteria), likely HFpEF (group 2b, 2 criteria) and definite HFpEF (2c, ≥3 criteria). The primary outcome was the change in HFpEF defining signs on neurohumoral (NT-proBNP) level and echocardiographic (number of echocardiographic criteria for diastolic dysfunction) level 6 months after restoration of sinus rhythm. Results In total, 69% of AF patients (with a preserved ejection fraction of ≥40%) fulfilled the criteria for HFpEF. In 23% of these patients, neurohumoral levels normalised after elimination of AF, and a normalisation of echocardiographic markers was seen in 58% of patients. Normalisation of HFpEF on a neurohumoral level was associated with numerically fewer AF recurrence at 1 year follow-up (23% versus 33% in patients with and without NT-proBNP &lt;125 pg/ml respectively, p=0.212). This favourable outcome was not observed in patients with a normalisation of echocardiographic markers. Conclusion In AF patients with definite restoration of sinus rhythm HFpEF may be reversed. This suggests that neurohumoral and echographic changes are caused by AF rather than by HFpEF. Normalisation of neurohumoral changes after definite restoration of sinus rhythm led to better outcome with regards to AF-recurrence, which could be used in prediction of prognosis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Left atrial dysfunction still exists in patients who obtain normal left atrial volume after successful ablation of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
K Inoue ◽  
T Nagai ◽  
A Fujii ◽  
Y Sasaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Late Recurrence ◽  
Reverse Remodeling ◽  
Long Term Outcomes ◽  
Af Ablation ◽  
Af Recurrence

Abstract Introduction Atrial fibrillation (AF) promotes left atrial (LA) remodeling and vice versa. LA volume index (LAVI) ≥34 mL/m2 is an established cut-off value for identifying an enlarged left atrium. Catheter ablation has become an established therapy for AF and provides a reduction of LA volume by maintaining sinus rhythm (reverse remodeling). However, the definition of LA reverse remodeling after AF ablation is undetermined. Purpose We hypothesized that patients with LA dilatation who obtain normal LA volume (LAVI &lt;34 mL/m2) after AF ablation would have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume could also obtain normal LA function with AF ablation. Methods We enrolled 140 AF patients with baseline LAVI ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 h and at 1 year after the procedure. Late recurrence was defined as AF recurrence &gt;1 year after the initial ablation. To define the normal range of LA function, age-and sex-matched 140 controls without a history of AF were also enrolled. Results After restoration of sinus rhythm, overall LA structural and functional parameters were significantly improved, and 75 patients (54%) had normal LA volume at the time of follow-up (Table). During a median follow-up of 44 (31–61) months, 32 patients (23%) experienced a late recurrence of AF. Patients who obtained normal LA volume after AF ablation had fewer late recurrences than those who did not (P&lt;0.01) (Figure). However, LA functional abnormalities still existed in AF patients, even if LA volume was normalized as in controls (Table). Conclusion Patients who obtain normal LA volume have better long-term outcomes of AF ablation than those who do not. Although AF ablation promotes beneficial effects on LA structure and function, LA function cannot be normalized even in patients who obtain normal LA volume after successful ablation. Thus, physicians should carefully consider long-term follow-up and residual AF risks, regardless of sinus rhythm restoration by catheter ablation. FUNDunding Acknowledgement Type of funding sources: None.

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