Prognostic significance of atrial fibrillation resolution after left ventricular assist device implantation

Background

The clinical impact of atrial fibrillation (AF) in patients undergoing left ventricular assist device (LVAD) implantation remains uncertain, particularly regarding whether the post-LVAD rhythm status carries prognostic value.

Methods

We retrospectively reviewed consecutive LVAD recipients at our institution between 2008 and 2023. Patients were categorized as no AF, new-onset AF, resolved AF, or recurrent AF according to rhythm status before and after implantation. The primary endpoint was hospitalization for heart failure, and the secondary endpoints were all-cause death, stroke, and major bleeding. Left atrial (LA) reverse remodeling was quantified as the percent reduction in LA diameter.

Results

Among 115 patients (mean age 46 years; 69.6% male; 14.8% ischemic etiology), 44 (38.3%) had AF before implantation. Over a median follow-up of 50.8 months, 29 of 44 patients (65.9%) had no AF recurrence by 3 months after implantation (resolved AF group), whereas 15 had AF (recurrent AF group); among the 71 patients without pre-LVAD AF, three developed new-onset AF. Compared with the recurrent AF group, the resolved AF group had a significantly lower risk of heart failure hospitalization (hazard ratio, 0.25; 95% confidence interval, 0.07–0.86; P = 0.027). LA diameter decreased to a greater extent in the resolved AF group than in the recurrent AF group (LA reduction rate: 24.5% vs. 10.8%; P = 0.032).

Conclusions

LVAD implantation was associated with LA reduction through reverse remodeling and led to AF resolution in a subset of patients. Patients with AF resolution experienced fewer heart failure events during LVAD support.