Impact of catheter ablation on ventricular function and atrial remodeling in heart failure patients with persistent AF
M Caetano Coelho, D Marques, P Silva Cunha, G Portugal, B Valente, H Santos, A Lousinha, M Martins OliveiraAbstract
Introduction
Atrial fibrillation (AF) and heart failure (HF) commonly occur together, constituting a complex clinical scenario. The persistent form of AF (PeAF) in patients with left ventricular systolic dysfunction (LVD) presents particular therapeutic challenges, as the long-term efficacy of catheter ablation (CA) in this population remains uncertain. Moreover, the sustained influence of rhythm control on structural and functional remodeling of the atria and ventricles has not yet been completely elucidated.
Aim
The present study aimed to investigate the clinical outcomes of CA in patients with PeAF and LVD, with a particular focus on quantifying echocardiographic markers of reverse remodeling in the left atrium (LA) and left ventricle (LV).
Methods
Consecutive patients diagnosed with PeAF and presenting a left ventricular ejection fraction (LVEF) below 50% who were referred for CA were prospectively included. Data on arrhythmia recurrence, symptom improvement, and echocardiographic parameters of atrial and ventricular remodeling were collected during a mean follow-up of 28.3± 21.2 months.
Results
A total of 40 patients were analyzed (mean age 58.4 ± 8.7 years; 72% male). The cohort presented an average CHA₂DS₂-VASc score of 2.6 ± 1.5, a body mass index of 28.2 ± 5.1 kg/m², and mean BNP levels of 450 ± 265 pg/mL. Cryoablation was applied in 12 patients (30%), while radiofrequency ablation was used in the remaining cases. No acute procedural complications occurred. During a mean follow-up period of approximately two years, AF recurrence was documented in 15 patients (37.5%), and 20% required a repeat ablation procedure. At three months post-CA, symptom burden had significantly improved, with patients achieving an average EHRA class of 1.15 ± 0.52. Echocardiographic evaluation revealed that LA size and indexed volume showed no statistically significant variation (49.6 ± 6.8 mm vs. 47.5 ± 8.6 mm, p = 0.44; 48.9 ± 16.8 mL/m² vs. 45.5 ± 17.8 mL/m², p = 0.62, respectively). However, LVEF demonstrated a marked improvement, increasing from 39 ± 8.6% to 50 ± 12.6% (p < 0.001). Baseline LVEF was identified as a predictor of AF recurrence (odds ratio = 1.377, p = 0.013).
Conclusions
In patients with persistent AF and reduced LVEF, catheter ablation achieved satisfactory rhythm control in a significant proportion of cases, with 63% maintaining sinus rhythm two years following a single intervention. This improvement was associated with a substantial enhancement of left ventricular function, suggesting meaningful reverse ventricular remodeling.For image description, please refer to the figure legend and surrounding text.