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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Different patterns of atrial remodeling after catheter ablation of chronic atrial fibrillation
Li-Wei Lo1, Hsuan-Ming Tsao, Yenn-Jiang Lin
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Recurrence of atrial fibrillation (AF) after ablation differs based on type. Paroxysmal AF recurrence shows reverse remodeling, while persistent AF recurrence involves progressive electrical changes without structural remodeling.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Research
Background:
- Catheter ablation for atrial fibrillation (AF) can lead to various tissue remodeling patterns.
- Understanding these patterns is crucial for improving ablation outcomes.
Purpose of the Study:
- To investigate the electrical and structural properties associated with AF recurrences after catheter ablation for chronic AF.
- To differentiate remodeling patterns between paroxysmal and persistent AF recurrences.
Main Methods:
- A stepwise catheter ablation procedure was performed on 120 patients with persistent/long-lasting persistent AF.
- Patients were categorized into groups based on AF recurrence type: paroxysmal (Group 1) or persistent (Group 2).
- Electrical (bipolar voltage) and structural (volume) properties of the left atrium were assessed before and after ablation, and during recurrence.
Main Results:
- Left atrial (LA) volume predicted recurrence type, being smaller in patients with paroxysmal recurrence (Group 1).
- Group 1 showed increased LA bipolar voltage and decreased LA volume after the second procedure, indicating reverse remodeling.
- Group 2 exhibited decreased LA bipolar voltage and unchanged LA volume, suggesting progressive electrical remodeling without structural changes.
- All Group 1 patients maintained sinus rhythm, compared to 14 in Group 2, after a 27-month follow-up.
Conclusions:
- Successful ablation of chronic AF with paroxysmal recurrence is associated with favorable reverse electrical and structural remodeling.
- Persistent AF recurrence after ablation is characterized by progressive electrical remodeling and a lack of structural remodeling.
- These findings highlight distinct remodeling pathways influencing outcomes after AF ablation.
Background:
Multiple remodeling patterns have been observed after catheter ablation of atrial fibrillation (AF).
Objective:
We aimed to clarify the electrical/structural properties associated with recurrences after ablation of chronic AF.
Methods:
After a stepwise ablation procedure in 120 consecutive patients with persistent/long-lasting persistent AF, 36 had a recurrence of AF (Group 1/Group 2: recurrence with paroxysmal/persistent AF, n = 16/20).
Results:
During the first procedure, the left atrial (LA) bipolar voltage did not differ between the 2 groups, and the LA volume was smaller in Group 1 than in Group 2 and it was the only factor predicting the recurrent types (P = 0.009, OR = 1.04). In the second procedure, the bipolar voltage of the global left atrium increased (1.33 ± 0.11 mV vs 1.76 ± 0.16 mV, P = 0.001) in Group 1 and decreased (1.31 ± 0.14 mV vs 0.90 ± 0.12 mV, P = 0.01) in Group 2, when compared with that of the first procedure. The LA low-voltage area (<0.5 mV) decreased in Group 1, and increased in Group 2. The LA volume (90 ± 8 cm(3) vs 72 ± 8 cm(3), P = 0.002) decreased in the second procedure in Group 1. It remained the same in Group 2. The right atrial substrates did not change between the procedures. After a follow-up of 27 ± 3 months, all patients in Group 1 and 14 patients in Group 2 remained in sinus rhythm (P = 0.02).
Conclusion:
A better outcome with reverse electrical and structural remodeling occurred after the ablation of chronic AF when the recurrence was paroxysmal AF. Progressive electrical remodeling without any structural remodeling developed in those with a recurrence involving persistent AF.
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