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

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\xa0years by cardiovascular magnetic resonance (CMR). Methods Patients with symptomatic ps. AF underwent CMR within 7\xa0days 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\u2009±\u20099\xa0years) were included. After a FU of 86\u2009±\u200913\xa0months, 23 patients had a successful outcome. In these patients, LVEF improved from 56\u2009±\u20095 to 62\u2009±\u20094% ( p \xa0=\u20090.02), but left atrial volume and ejection fraction (LAV, LAEF) remained unchanged (105\u2009±\u200925 to 98\u2009±\u200934, p \u2009=\u20090.44; 34\u2009±\u200910 to 36\u2009±\u200911, p \u2009=\u20090.6, respectively). In 14 patients with a BMI <\u200930 and no left ventricular hypertrophy (LVH), LAV decreased (104\u2009±\u200930 to 82\u2009±\u200926\xa0ml, p \u2009=\u20090.01) and LAEF improved (33\u2009±\u200912 to 40\u2009±\u200911%, p \u2009=\u20090.03). In 9 patients with successful outcome and either BMI ≥\u200930 or LVH, LAV increased (110\u2009±\u200926 to 125\u2009±\u200930\xa0ml, p \u2009=\u20090.03) and LAEF deteriorated (35\u2009±\u200911 to 31\u2009±\u200910%, p \u2009=\u20090.04). 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 ≥\u200930 or left ventricular hypertrophy, further left atrial enlargement occurs despite successful outcome.