Electrogram Organization Predicts Left Atrial Reverse Remodeling After the Restoration of Sinus Rhythm by Catheter Ablation in Patients With Persistent Atrial Fibrillation

Study Questions:

Are there any electrophysiological predictors of reverse remodeling after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

Ninety patients (mean age 61 years) with a left atrial volume index (LAVi) ≥32 ml/m2 underwent RFCA of persistent AF. An echocardiogram was performed the day before RFCA and 1 year after the final ablation procedure. Baseline electrocardiograms and magnetocardiograms were analyzed by fast Fourier transform techniques, and an organization index (OI) was calculated. Reverse remodeling was defined as a post-ablation reduction in LAVi of ≥23%.

Results:

During a mean follow-up of 18 months after the final procedure, and after a mean of 1.4 procedures/patient, 73/90 patients (81%) were free of AF. Among these 73 patients, 35 patients met the criterion for reverse remodeling, with a decrease in LAVi from a mean of 43-27 ml/m2. The OI was significantly higher in these patients than in the patients without reverse remodeling (0.51 vs. 0.42). The variables that were independently associated with reverse remodeling consisted of OI, younger age, and higher atrial natriuretic peptide levels.

Conclusions:

Electrogram organization is a predictor of a reduction in LA size after successful RFCA of persistent AF.

Perspective:

One of the factors that can cause disorganization of atrial electrograms during AF is atrial fibrosis. Less atrial electrogram disorganization probably correlates with less atrial fibrosis. This explains why a higher baseline degree of electrogram organization makes it more likely that LA enlargement will be reversible after AF is eliminated.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound

Keywords: Follow-Up Studies, Electrophysiologic Techniques, Cardiac, Electrocardiography, Fourier Analysis, Heart Rate, Atrial Fibrillation, Hypertrophy, Fibrosis, Atrial Natriuretic Factor, Catheter Ablation, Magnetocardiography, Echocardiography


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