Left ventricular wall thickness and functional recovery after atrial fibrillation ablation in patients with systolic...

Left ventricular functional recovery after atrial fibrillation (AF) ablation varies widely in patients with systolic dysfunction.

This study aimed to evaluate whether baseline left ventricular wall thickness (LVWT) and its regional heterogeneity predict recovery of left ventricular ejection fraction (LVEF) after AF ablation.

Of 5535 consecutive patients undergoing first-time AF ablation (2012-2024), 342 with a baseline LVEF of <50% (median age 64 years; 86% male; 19% with previous myocardial infarction) were retrospectively analyzed. Multidetector computed tomography was performed before ablation, and LVWT was quantified using a 16-segment model at end-diastole. Mean LVWT and its standard deviation (SD) across segments were calculated. The primary endpoint was the 6-month change in LVEF (ΔLVEF) on echocardiography.

Median mean LVWT and SD of LVWT were 7.03 mm (6.19-8.00) and 1.20 mm (0.95-1.50), respectively. LVEF improved from 38.7% (32.0%-44.4%) to 56.0% (44.3%-62.0%) at 6 months (P < .001). In multivariable linear regression, higher mean LVWT was independently associated with greater ΔLVEF (1.72% per 1 mm; 95% confidence interval, 0.83-2.61; P < .001), whereas greater LVWT heterogeneity (SD) was associated with less ΔLVEF (-4.02% per 1 mm; 95% confidence interval, -6.64 to -1.40; P = .003). Patients with reduced thickness and high heterogeneity (mean LVWT <7.0 mm; SD of LVWT >1.2 mm) had the highest incidence of heart failure hospitalization or cardiovascular death.

Baseline LVWT and its regional heterogeneity were independently associated with postablation functional recovery in patients with a baseline LVEF of <50%. Preprocedural LVWT assessment may help estimate myocardial reserve and expected functional recovery after AF ablation.