Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation
Background Although successful atrial fibrillation (AF) ablation can maintain sinus rhythm and reduce the left atrial (LA) dimension, blunted LA reverse remodeling can be observed in patients with atrial myopathy. We explored the potential mechanisms and long‐term outcomes in patients with blunted L...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030818 |
| _version_ | 1827342072022040576 |
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| author | Moon‐Hyun Kim Tae‐Hoon Kim Inseok Hwang Je‐Wook Park Hee Tae Yu Jae‐Sun Uhm Boyoung Joung Moon‐Hyoung Lee Chun Hwang Hui‐Nam Pak |
| author_facet | Moon‐Hyun Kim Tae‐Hoon Kim Inseok Hwang Je‐Wook Park Hee Tae Yu Jae‐Sun Uhm Boyoung Joung Moon‐Hyoung Lee Chun Hwang Hui‐Nam Pak |
| author_sort | Moon‐Hyun Kim |
| collection | DOAJ |
| description | Background Although successful atrial fibrillation (AF) ablation can maintain sinus rhythm and reduce the left atrial (LA) dimension, blunted LA reverse remodeling can be observed in patients with atrial myopathy. We explored the potential mechanisms and long‐term outcomes in patients with blunted LA reverse remodeling after successful AF catheter ablation. Methods and Results We included 1685 patients who underwent baseline and 1‐year follow‐up echocardiograms, had a baseline LA dimension ≥40 mm, and did not have a recurrence of AF within a year. The patients were divided into tertile groups according to the delta value of the change in LA dimension on the preprocedure and 1‐year postprocedure echocardiography. After propensity score matching for age, sex, AF type, and LA dimension, 1272 patients were finally included in the analyses (424 in each group; the least/blunted, moderate, and the most reverse remodeling group). The patients in the T1 group (blunted LA reverse remodeling) were independently associated with higher left ventricular mass index (odds ratio [OR], 1.014 [95% CI, 1.005–1.022], P=0.001), change in ΔH2FPEF score (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score (OR, 1.445 [95% CI, 1.121–1.861], P=0.004), ventricular epicardial adipose tissue volume (OR, 1.010 [95% CI, 1.003–1.017], P=0.003), thinner LA wall thickness (OR, 0.461 [95% CI, 0.271–0.785], P=0.004), lower LA voltage (OR, 0.670 [95% CI, 0.499–0.899], P=0.008), and showed higher long‐term AF recurrence (log‐rank P<0.001) than other groups. Conclusions Blunted LA reverse remodeling after AF catheter ablation, which is suggestive of atrial myopathy, was independently associated with a larger ventricular epicardial adipose tissue volume and worsening of H2FPEF score. Blunted LA reverse remodeling after AF catheter ablation was also an independent predictor for higher recurrences of AF post‐1‐year AF catheter ablation. |
| first_indexed | 2024-03-07T22:02:23Z |
| format | Article |
| id | doaj.art-914441c71e4a44aebed6993921f66414 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:23Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-914441c71e4a44aebed6993921f664142024-02-24T04:06:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113310.1161/JAHA.123.030818Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial FibrillationMoon‐Hyun Kim0Tae‐Hoon Kim1Inseok Hwang2Je‐Wook Park3Hee Tae Yu4Jae‐Sun Uhm5Boyoung Joung6Moon‐Hyoung Lee7Chun Hwang8Hui‐Nam Pak9Yonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaYonsei University College of Medicine, Yonsei University Health System Seoul Republic of KoreaBackground Although successful atrial fibrillation (AF) ablation can maintain sinus rhythm and reduce the left atrial (LA) dimension, blunted LA reverse remodeling can be observed in patients with atrial myopathy. We explored the potential mechanisms and long‐term outcomes in patients with blunted LA reverse remodeling after successful AF catheter ablation. Methods and Results We included 1685 patients who underwent baseline and 1‐year follow‐up echocardiograms, had a baseline LA dimension ≥40 mm, and did not have a recurrence of AF within a year. The patients were divided into tertile groups according to the delta value of the change in LA dimension on the preprocedure and 1‐year postprocedure echocardiography. After propensity score matching for age, sex, AF type, and LA dimension, 1272 patients were finally included in the analyses (424 in each group; the least/blunted, moderate, and the most reverse remodeling group). The patients in the T1 group (blunted LA reverse remodeling) were independently associated with higher left ventricular mass index (odds ratio [OR], 1.014 [95% CI, 1.005–1.022], P=0.001), change in ΔH2FPEF score (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score (OR, 1.445 [95% CI, 1.121–1.861], P=0.004), ventricular epicardial adipose tissue volume (OR, 1.010 [95% CI, 1.003–1.017], P=0.003), thinner LA wall thickness (OR, 0.461 [95% CI, 0.271–0.785], P=0.004), lower LA voltage (OR, 0.670 [95% CI, 0.499–0.899], P=0.008), and showed higher long‐term AF recurrence (log‐rank P<0.001) than other groups. Conclusions Blunted LA reverse remodeling after AF catheter ablation, which is suggestive of atrial myopathy, was independently associated with a larger ventricular epicardial adipose tissue volume and worsening of H2FPEF score. Blunted LA reverse remodeling after AF catheter ablation was also an independent predictor for higher recurrences of AF post‐1‐year AF catheter ablation.https://www.ahajournals.org/doi/10.1161/JAHA.123.030818atrial fibrillationatrial myopathyatrial reverse remodelingcatheter ablationepicardial adipose tissue |
| spellingShingle | Moon‐Hyun Kim Tae‐Hoon Kim Inseok Hwang Je‐Wook Park Hee Tae Yu Jae‐Sun Uhm Boyoung Joung Moon‐Hyoung Lee Chun Hwang Hui‐Nam Pak Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation atrial myopathy atrial reverse remodeling catheter ablation epicardial adipose tissue |
| title | Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation |
| title_full | Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation |
| title_fullStr | Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation |
| title_full_unstemmed | Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation |
| title_short | Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation |
| title_sort | clinical characteristics and rhythm outcomes in patients with atrial myopathy after successful catheter ablation of atrial fibrillation |
| topic | atrial fibrillation atrial myopathy atrial reverse remodeling catheter ablation epicardial adipose tissue |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030818 |
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