AI Article Synopsis
- Left atrial (LA) function is a key predictor for cardiovascular events and can be affected by catheter ablation treatment for atrial fibrillation (AF), which typically aims to restore normal heart rhythm.
- A study involving 616 patients demonstrated that lower post-ablation LA emptying fraction (LAEF) significantly correlates with higher recurrence rates of AF, with a notable recurrence-free rate of 79% among those with preserved LAEF compared to only 40% for those with reduced LAEF.
- Predictors of reduced LAEF included low pre-ablation LAEF, larger pre-ablation LA volume, lower body mass index (BMI), and female gender, signaling potential risk factors for poorer outcomes post-ablation.
Article Abstract
Left atrial (LA) function can help predict various cardiovascular events. Catheter ablation for atrial fibrillation (AF) modifies baseline LA function through the maintenance of sinus rhythm and myocardial injury. We investigated the impact of post-ablation LA function on recurrence of AF after ablation and identified the predictors of reduced post-ablation LA function. A total of 616 patients who underwent AF ablation (paroxysmal, N = 310; non-paroxysmal, N = 306) were retrospectively examined with cardiac computed tomography at baseline and 3 months after the final ablation procedure. Post-ablation LA emptying fraction (LAEF) was calculated. We evaluated the association between LAEF and recurrence of AF after the final ablation procedure. Further, we assessed the predictors of reduced LAEF. The recurrence rate of AF was 72.7% after the final ablation procedure [median follow-up 48 months (48.0, 48.0), total number of ablation sessions: 1.4 ± 0.7]. Multivariate analysis revealed that LAEF was associated with the recurrence of AF (hazard ratio/10% increase: 0.62, 95% confidence interval: 0.51-0.75, P < 0.0001). LAEF had a mild predictive power for recurrence of AF (c-statistics: 0.670, optimal cutoff: 26.36%, P < 0.0001). The recurrence-free proportion among patients with reduced LAEF (< 26.36%, N = 100) and those with preserved LAEF (≥ 26.36%, N = 516) was 40% and 79%, respectively (P < 0.0001). The predictors of reduced LAEF were low pre-ablation LAEF, high pre-ablation LA volume, low body mass index (BMI), and female sex. Further, reduced LAEF was associated with the total number of ablation sessions and extra-pulmonary vein LA ablation. In conclusion, reduced LAEF was associated with recurrence of AF after ablation. Advanced LA remodeling, low BMI, and female sex could predict reduced LAEF. Although additional ablation was associated with reduced LAEF, it remains unclear whether reduced LAEF resulted from the additional ablation. Reduced LAEF might help stratify patients with ablation-refractory AF.
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