Assessment of the Degree of Left Atrial Fibrosis in Patients with Different Forms of Atrial Fibrillation

• Published in: Ukraïnsʹkyĭ z︠h︡urnal sert︠s︡evo-sudynnoï khirurhiï Vol. 33; no. 2; pp. 62 - 69
• Main Authors: Perepeka, Eugene O., Bodnarevska, Elina V., Ishchenko, Mykhailo S., Kravchuk, Borys B.
• Format: Journal Article
• Language: English
• Published: Professional Edition Eastern Europe 25.06.2025
• Subjects: atrial cardiomyopathy; catheter ablation; cryoballoon ablation; electrical cardioversion; heart failure; pacemaker; pulsed field ablation
• ISSN: 2664-5963; 2664-5971
• DOI: 10.63181/ujcvs.2025.33(2).62-69

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, which has a significant impact on the health of patients worldwide. Left atrial fibrosis (LAF) is considered an irreversible form of remodeling that occurs in response to inflammation, stretching, or overload of the left atrium. The prevalence and degree of LAF may be associated with the prognosis and treatment outcomes after catheter ablation. Aim. To determine whether the degree of left atrial fibrosis is associated with the progression of atrial fibrillation. Materials and methods. During the period from January 2023 to December 2024, the State Research Institute of Cardiology named after M.M. Amosov National Academy of Medical Sciences of Ukraine performed 58 MRI studies with late contrast enhancement with gadolinium to study the degree of fibrosis of different chambers of the heart. Thirty-six of these patients were diagnosed with AF. In 12 patients, catheter ablation for atrial fibrillation was subsequently performed (radiofrequency, cryoballoon ablation, or pulsed field ablation). In 10, an attempt at electrical cardioversion without catheter intervention was performed. Results. Among the 34 patients included in the study, 13 (38 %) had paroxysmal AF, 14 (41 %) had persistent AF, and 7 (21 %) had permanent AF. Among the patients with paroxysmal AF, 9 (69 %) had stage I of left atrial fibrosis (LAF), 4 (31 %) had LAF stage II. No patients with LAF stage III-IV were observed in the paroxysmal AF group. In the persistent AF group (n = 14, 41 %), LAF stage I was observed in 4 (29 %) patients, LAF stage II in 8 (57 %), and LAF stage III and IV in 1 (7 %) patient in each group. In the patients with permanent AF (n = 7, 21 %), no patients with LAF stage I were observed. LAF stage II was observed in 4 (57 %) patients, LAF stage III in 2 (28 %), and LAF stage IV in 1 (14 %). The analysis showed a statistically significant decrease in left ventricular ejection fraction in patients with progressive AF. In the paroxysmal group, the mean LVEF was 55.75 ± 11.05 %, while in patients with persistent AF it decreased to 47.46 ± 13.88 %, and in chronic AF it decreased to 36.29 ± 12.08 % (p = 0.018). Conclusions. According to our results, the degree of fibrosis of the left atrium correlates with the stage of progression of atrial fibrillation.