Atrial fibrillation (AF) is accompanied by various types of remodeling, including volumetric enlargement and histological degeneration. Electrical remodeling reportedly reflects histological degeneration.

Purpose

To clarify the differences in determinants and clinical impacts among types of remodeling.

Methods

This observational study included 1118 consecutive patients undergoing initial ablation for AF. Patients were divided into four groups: minimal remodeling (left atrial volume index [LAVI] < mean value and no low-voltage area [LVA], n = 477); volumetric remodeling (LAVI ≥ mean value and no LVA, n = 361); electrical remodeling (LAVI < mean value and LVA presence, n = 96); and combined remodeling (LAVI ≥ mean value and LVA presence, n = 184). AF recurrence and other clinical outcomes were followed up for 2 and 5 years, respectively.

Results

Major determinants of each remodeling pattern were high age for electrical (odds ratio = 2.32, 95% confidence interval = 1.68–3.25) and combined remodeling (2.57, 1.88–3.49); female for electrical (3.85, 2.21–6.71) and combined remodeling (4.92, 2.90–8.25); persistent AF for combined remodeling (7.09, 3.75–13.4); and heart failure for volumetric (1.71, 1.51–2.53) and combined remodeling (2.21, 1.30–3.75). Recurrence rate after initial ablation increased in the order of minimal remodeling (20.1%), volumetric (27.4%) or electrical remodeling (36.5%), and combined remodeling (50.0%, p < .0001). A composite endpoint of heart failure, stroke, and death occurred in the order of minimal (3.4%), volumetric (7.5%) or electrical (8.3%), and combined remodeling (15.2%, p < .0001).

Conclusion

Volumetric, electrical, and combined remodeling were each associated with a unique patient background, and defined rhythm and other clinical outcomes.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Volume35, Issue1

January 2024

Pages 171-181

Clinical impact of left atrial remodeling pattern in patients with atrial fibrillation: Comparison of volumetric, electrical, and combined remodeling

Abstract

Introduction

Purpose

Methods

Results

Conclusion

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

References

Information

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Clinical impact of left atrial remodeling pattern in patients with atrial fibrillation: Comparison of volumetric, electrical, and combined remodeling

Abstract

Introduction

Purpose

Methods

Results

Conclusion

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

References

Related

Information