Abstract 17658: Prevalence and Predictors of Left Ventricular Reverse Remodeling After Radiofrequency Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction

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Introduction: Atrial fibrillation (AF) causes electrical and structural remodeling of both the left atrium (LA) and the left ventricle (LV). Restoration of sinus rhythm can improve cardiac function and promote structural reverse remodeling. The purpose of this study was to determine the prevalence and predictors of left ventricular reverse remodeling (LVRR) after radiofrequency catheter ablation (RFCA) for AF in patients with impaired LV function.

Methods and Results: This was a single center retrospective observational study. Among 1939 consecutive patients who underwent first-time RFCA for AF from January 2012 to March 2017 in our institute, 218 patients (11%) had a baseline LV ejection fraction (LVEF) <50%. Among them, we enrolled 193 patients who were subjected to 64-slice multi-detector computed tomography scanning to evaluate LA and LV function at baseline and 3 months after RFCA. We calculated LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LVEF using the computed tomography and evaluated LVRR, which was defined as a decrease in LVESV ≥15%. Although there was no significant change in the LVEDV (from 118±55ml to 116±56ml, p = 0.43), we found significant reduction in the LVESV (from 73±47ml to 48±51ml, p <0.001) and improvement in the LVEF (from 40±9% to 62±15%, p <0.001). LVRR was observed in 146 patients (76%) even 3 months after RFCA. Multivariate logistic regression analysis after adjustment for age and gender revealed that the persistent form of AF (odds ratio, 3.05; 95% confidence interval, 1.30 - 7.17; p = 0.01) and a history of coronary artery disease (odds ratio, 0.24; 95% confidence interval, 0.08 - 0.71; p = 0.01) were significant predictors of LVRR.

Conclusions: Among patients with impaired LV function, a significant proportion of patients achieved LVRR after RFCA for AF. Persistent form of AF and absence of coronary artery disease were positively associated with LVRR. Treatment of persistent AF by catheter ablation should be considered as an important option of heart failure management, especially for patients with non-ischemic cardiomyopathy with concurrent LV dysfunction.

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