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Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation

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Abstract

Purpose

Adverse left atrial (LA) remodeling is known to be associated with persistent atrial fibrillation (PeAF). The time course and pattern of reversal of LA remodeling following catheter ablation is poorly understood. We aimed to evaluate LA chamber volumes and dimensions, LA conduction velocities, and LA bipolar voltages at baseline and at 2 months after catheter ablation for PeAF.

Methods

Twenty-three patients with PeAF underwent detailed LA mapping during fixed rate atrial pacing using the CARTO3 navigation system prior to undergoing pulmonary vein isolation. All patients returned for protocol-mandated repeat electrophysiology study at 2 months, irrespective of symptoms or arrhythmia recurrence, during which all measurements were repeated using an identical mapping protocol. Patients then underwent daily ECG monitoring for 12 months.

Results

Nineteen out of twenty-three (83.6%) patients had durable PVI of all veins at repeat electrophysiology study, while 4 (17.4%) patients had late reconnection of a single vein each. In the blinded offline analysis, LA volume at follow-up was significantly lower as compared with baseline (55 ± 14 mL/m2 vs. 65 ± 15 mL/m2, P < 0.001). LA conduction velocities were significantly greater at 2 months (0.90 ± 0.13 m/s vs. 0.78 ± 0.13 m/s, P = 0.01). There was non-uniform regional LA voltage evolution, with a significant increase in bipolar voltages observed on the LA posterior wall (2.18 ± 0.85 mV vs. 1.83 ± 0.49 mV, P = 0.04), but not elsewhere. Individual variables of remodeling were not associated with AF recurrence.

Conclusion

Significant structural and electrical reverse remodeling of the LA can be seen as early as 2 months following successful catheter ablation for PeAF.

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Funding

This investigation was performed in patients enrolled in a study (ClinicalTrials.gov NCT02628730) funded by Biosense Webster, Inc. (Investigator-Initiated Study Grant IIS-385). The funding source had no involvement in the design, conduct, or analysis of this study.

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Authors and Affiliations

  1. Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK

    Baptiste Maille, Ahmed Hussein, Matthew Shaw, Vivek Chaturvedi, Emmanuel Williams, Maureen Morgan, Christina Ronayne, Richard L. Snowdon & Dhiraj Gupta

  2. Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK

    Moloy Das

Authors
  1. Baptiste Maille
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  2. Moloy Das
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  3. Ahmed Hussein
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  4. Matthew Shaw
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  5. Vivek Chaturvedi
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  6. Emmanuel Williams
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  7. Maureen Morgan
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  8. Christina Ronayne
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  9. Richard L. Snowdon
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  10. Dhiraj Gupta
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Corresponding author

Correspondence to Dhiraj Gupta.

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All patients gave written informed consent before study enrolment and the study was approved by the United Kingdom National Research Ethics Service and the institutional research committee.

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Maille, B., Das, M., Hussein, A. et al. Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation. J Interv Card Electrophysiol 58, 9–19 (2020). https://doi.org/10.1007/s10840-019-00576-1

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  • DOI: https://doi.org/10.1007/s10840-019-00576-1

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