Abstract 5681: Reverse Remodeling of Left Atrium after Catheter Ablation for Atrial Fibrillation: Its Impact on Recurrence and Left Ventricular Function
Atrial fibrillation (AF) is associated with enlargement of the left atrium (LA). The objective of this study was to investigate the impact of catheter ablation (CA) on LA size in relation to left ventricular systolic and diastolic function and to the recurrence of AF in patients with AF. Study population consisted of 81 patients undergoing CA for AF. We performed contrast 64-row multidetector CT before and >3 month after CA to measure LA and LV volumes. They underwent echo-Doppler studies at same time. We measured peak-E velocity and peak early diastolic mitral annulus velocity (e′). E/e′ ratio was calculated as an estimate of LV filling pressure. AF recurrence was observed in 20 (35%) of 57 paroxysmal AF patients and 15 (63%) of 24 chronic AF patients. Patients were divided in two groups based on the presence or absence of AF recurrence. Initial LA end-systolic volume (LAESV) was greater in the recurrence group (71 +/− 38 vs. 49 +/− 27 ml, p<0.01). LAESV significantly decreased >3 months after CA in both group, but it was still greater in the recurrence group (53 +/− 37 vs. 38 +/− 21 ml, p<0.01). Only non-recurrent group showed a decrease in LVESV and an increase in LVEF after CA (35 +/− 22 to 30 +/− 22 ml, p=0.01, 66 +/− 12 to 72 +/− 11 %, p<0.01, respectively). At baseline study, e′ velocity was lower (6.6 +/− 2.1 vs. 7.6 +/− 1.9 cm/s, p=0.02), and E/e′ ratio was higher (13.6 +/− 8.8 vs. 9.8 +/− 5.6, p=0.02) in the recurrence group. The e′ velocity and the E/e′ ratio did not show significant change after CA. Reduced LV diastolic function, elevated LV filling pressure and greater LA size are factors associated with AF recurrence after CA. Reverse LA remodeling is observed after CA regardless of AF recurrence. Maintaining sinus rhythm is associated with smaller LA size and improvement in LV systolic function despite improvement in diastolic function.