Clinical Implications of Left Atrial and Ventricular Reverse Remodeling After Atrial Fibrillation Ablation in Patients With Systolic Dysfunction

Background Catheter ablation of atrial fibrillation (AF) is an effective treatment to achieve left atrial (LA) and left ventricular (LV) reverse remodeling in patients with systolic dysfunction. However, the relationship between LA and LV reverse remodeling (LARR and LVRR) and their clinical implications remains unclear. Methods Among 5287 consecutive patients undergoing first‐time AF ablation, 620 with baseline LV ejection fraction <50% were evaluated. They underwent multidetector computed tomography at baseline and 3 months after ablation. LARR and LVRR were defined as ≥15% reductions in the LA and LV end‐systolic volume, respectively. The relationship between LARR and LVRR and their impact on clinical outcomes was investigated. Results AF ablation reduced the LA and LV end‐systolic volumes, with reduction rates of 24%±16% and 39%±24%, respectively (r=0.54, P <0.001). During a follow‐up of 50.4 months, patients with LARR−/LVRR− (n=86) showed the highest incidence of AF recurrence (50.0%) and composite of heart failure hospitalization or cardiovascular death (25.6%). Patients with LARR+/LVRR− (n=43) exhibited similar AF recurrence but the second highest incidence of the composite outcomes (16.3%) compared with those with LARR−/LVRR+ (n=95) and LARR+/LVRR+ (n=396). Age‐ and sex‐adjusted Cox regression analysis revealed that LARR−/LVRR− alone was associated with AF recurrence (hazard ratio [HR], 2.01 [95% CI, 1.42–2.85], P <0.001), whereas LARR−/LVRR− (HR, 6.73 [95% CI, 3.48–13.0]) and LARR+/LVRR− (HR, 4.58 [95% CI, 1.86–11.3]) were associated with the composite end point. Conclusions LARR and LVRR were moderately correlated after AF ablation in patients with systolic dysfunction. Their combined assessment delineated distinct postablation trajectories and may improve individual risk stratification.