Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation
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.
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.
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.
Significant structural and electrical reverse remodeling of the LA can be seen as early as 2 months following successful catheter ablation for PeAF.
KeywordsLeft atrium reverse remodeling Atrial fibrillation Ablation Mapping Atrial fibrosis Low-voltage points Conduction velocities
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.
Compliance with ethical standards
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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