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Long-term left atrial remodeling after ablation of persistent atrial fibrillation: 7-year follow-up by cardiovascular magnetic resonance imaging

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Restoration of sinus rhythm in patients with persistent atrial fibrillation (ps. AF) induces reverse atrial remodeling and improvement of left ventricular function. We evaluated the effect of ablative treatment on cardiac remodeling after a long follow-up period of 7 years by cardiovascular magnetic resonance (CMR).

Methods

Patients with symptomatic ps. AF underwent CMR within 7 days prior to the ablation procedure. Left atrial and ventricular volumes were measured. All patients underwent circumferential pulmonary vein isolation. At the end of follow-up (FU), a CMR and 7-day ECG registration were performed.

Results

Forty-two patients (67 ± 9 years) were included. After a FU of 86 ± 13 months, 23 patients had a successful outcome. In these patients, LVEF improved from 56 ± 5 to 62 ± 4% (p = 0.02), but left atrial volume and ejection fraction (LAV, LAEF) remained unchanged (105 ± 25 to 98 ± 34, p = 0.44; 34 ± 10 to 36 ± 11, p = 0.6, respectively). In 14 patients with a BMI < 30 and no left ventricular hypertrophy (LVH), LAV decreased (104 ± 30 to 82 ± 26 ml, p = 0.01) and LAEF improved (33 ± 12 to 40 ± 11%, p = 0.03). In 9 patients with successful outcome and either BMI ≥ 30 or LVH, LAV increased (110 ± 26 to 125 ± 30 ml, p = 0.03) and LAEF deteriorated (35 ± 11 to 31 ± 10%, p = 0.04).

Conclusions

Successful ablative treatment of atrial fibrillation is associated with reverse left atrial remodeling and improvement of left atrial and ventricular function. In patients with a BMI ≥ 30 or left ventricular hypertrophy, further left atrial enlargement occurs despite successful outcome.

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Abbreviations

ps. AF:

persistent atrial fibrillation

BMI:

body mass index

CMR:

cardiovascular magnetic resonance

ECG:

electrocardiogram

FU:

follow-up

LA:

left atrium

LAV:

left atrial volume

LAV_D:

diastolic left atrial volume

LAV_S:

systolic left atrial volume

LAEF:

left atrial ejection fraction

LASV:

left atrial systolic volume

LVEF:

left ventricular ejection fraction

LVH:

left ventricular hypertrophy

PV:

pulmonary veins

RF:

radiofrequency

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Acknowledgments

We thank Anne Wölffel-Gale for editorial assistance.

Funding

This study was supported by a grant from the Friends of the German Heart Center Berlin.

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Author notes

  1. Charalampos Kriatselis and Tatjana Unruh contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Angiology, Nephrology and Intensive Care Medicine, Vivantes Klinikum Neukölln, Rudower Strasse 48, 11351, Berlin, Germany

    Charalampos Kriatselis

  2. Department of Internal Medicine, Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Charalampos Kriatselis, Tatjana Unruh, Jan Kaufmann, Jin-Hong Gerds-Li, Sebastian Kelle, Rolf Gebker & Burkert Pieske

  3. Department of Cardiology/Rhythmology, HELIOS Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany

    Cosima Jahnke & Ingo Paetsch

Authors
  1. Charalampos Kriatselis
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Correspondence to Charalampos Kriatselis.

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Kriatselis, C., Unruh, T., Kaufmann, J. et al. Long-term left atrial remodeling after ablation of persistent atrial fibrillation: 7-year follow-up by cardiovascular magnetic resonance imaging. J Interv Card Electrophysiol 58, 21–27 (2020). https://doi.org/10.1007/s10840-019-00584-1

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  • DOI: https://doi.org/10.1007/s10840-019-00584-1

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