Early Left Ventricular Reverse Remodeling After Catheter Ablation of Atrial Fibrillation is Associated With Lower Recurrence Rates and Improved Prognosis in Patients With Left Ventricular Systolic Dysfunction.

Introduction: Left ventricular (LV) reverse remodeling (LVRR) following catheter ablation (CA) of atrial fibrillation (AFCA) has not been fully elucidated. This study investigated the clinical impact of early LVRR after AFCA on prognosis in patients with LV systolic dysfunction (LVSD).

Methods: Of 1,989 consecutive patients undergoing first-time AFCA, 302 patients with a baseline LV ejection fraction < 50% were included. LVRR was defined as a decrease in the LV end-systolic volume of ≥ 15% on an echocardiography at 3 months after AFCA. The clinical outcomes and prognoses were compared between patients with and without LVRR.

Results: LVRR was observed in 191 (63%) patients at 3 months after AFCA. A multiple logistic regression analysis demonstrated that non-paroxysmal AF, non-cardiomyopathy, absence of early recurrence, QRS duration ≤ 120 ms were significantly associated with the LVRR after 3 months. During a median follow-up period of 30 (16-50) months, patients with LVRR showed a lower incidence of AF recurrence (24.1% vs. 39.6%; p = 0.004), heart failure hospitalizations (5.8% vs. 13.5%; p = 0.022), all-cause mortality (4.2% vs. 11.7%; p = 0.017), and composite events including recurrence, heart failure hospitalization, and mortality (26.7% vs. 48.7%; p < 0.001) compared to those without. A multivariate Cox regression analysis revealed that the LVRR at 3 months was independently associated with AF recurrence-free survival (hazard ratio, 0.624, p = 0.029) and composite endpoint (hazard ratio, 0.573, p = 0.006) after AFCA.

Conclusions: The LVRR emerged in two-third of the patients with LVSD after 3 months of AFCA. Early LVRR was associated with favorable clinical outcomes and prognoses after AFCA.