Temporal dynamics of left atrial reverse remodeling predicts atrial fibrillation ablation outcome: A 3-year longitudinal study

Long-term dynamic changes in the left atrium (LA) following radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) remain unclear. We aimed to unveil the temporary dynamics of LA reverse remodeling and the optimal echocardiographic indicator and timing for evaluating RFCA outcomes in this 3-year longitudinal study.

Data were retrospectively collected from 400 consecutive patients undergoing RFCA for AF (paroxysmal 71%). Echocardiographic examinations were performed at 1 day, and 1, 3, 6, 12, 18, 24, 30, and 36 months after RFCA. Patients were classified into three groups based on RFCA outcomes. We constructed mean response curves to visualize the tendency between echocardiographic indicators and time across groups. Proportional odds models were built to determine the optimal echocardiographic indicator and follow-up time point for distinguishing the outcome group.

After a mean follow-up duration of 81 ± 24 months, free of AF was achieved in 357 patients. Mean response curves of echocardiographic indicators differed between patients with and without AF recurrence. A flat slope of mean response curves in the first 3 months and deterioration of echocardiographic indices starting 18 months after RFCA indicated higher risks of AF recurrence. LA linear ablation didn’t affect the longitudinal trend of echocardiographic indicators in paroxysmal AF, but retarded LA reverse remodeling process in persistent AF. LAEF at 36 months had the highest c-index for predicting AF recurrence during a median follow-up period of 80 months.

The longitudinal trend of echocardiographic indicators reflects long-term LA remodeling and can provide important information for individualized treatment strategies.