Impact of restoration of sinus rhythm after catheter ablation of atrial fibrillation on reverse cardiac remodelling

• Published in: Europace (London, England) Vol. 26; no. Supplement_1
• Main Authors: Alatic, J, Suran, D, Pirnat, M, Vokac, D, Naji, H F
• Format: Journal Article
• Language: English
• Published: 24.05.2024
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euae102.176

Abstract Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used for the treatment of atrial fibrillation (AF). Restoration of sinus rhythm in patients with AF is of vital importance, because AF induces the development of heart failure (HF) through various pathophysiological mechanisms, one of them is epicardial adipose tissue (EAT). EAT is a type of visceral adipose tissue that is in direct contact with the myocardium. Under pathological conditions it serves as a direct and indirect factor in pathogenesis of AF. It is also an established prognostic factor after CA of AF recurrence. Since cardiac magnetic resonance (CMR) represent the gold standard for the measurement of volume and muscle mass, it has been used more and more for the assessment of EAT volume lately. Purpose The aim of our study was to investigate the impact of restoration of sinus rhythm on EAT volume, and cardiac function and morphology evaluated by the CMR. Methods We prospectively included 17 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent cardiac magnetic CMR prior to radiofrequency CA with PVI and 6 months thereafter in order to quantify periatrial EAT volumes and evaluate cardiac morphological and functional characteristics. AF recurrence rate was diagnosed by serial ECG recordings, Holter ECG monitoring and AF suggestive symptoms within 6 months of follow-up period. Results 17 patients, mainly male (76.5 %) with an average age of 62.35 ± 12.10 years were included in our study. The average body mass index (BMI) was 29.0 ± 4.71 kg/m2. Most patients had paroxysmal AF prior to CA (88.2 %). The recurrence rate of AF was 35.3 % after 6 months of follow-up. By performing CMR after 6 months of CA we observed lower median periatrial EAT volume (36.00 mL (IQR 38.25 mL) vs. 27.45 mL (IQR 30.94 mL); p= 0.004) and lower median left ventricular mass (LVM) (104.0 g/m2 (IQR 38 g/m2) vs. 100.0 g/m2 (IQR 42 g/m2); p= 0.019). Furthermore, when patients were stratified based on the AF status after the follow-up period, we observed that the patients who remained AF-free had significantly lower median periatrial EAT volumes (38.90 mL (IQR 43.84 mL) vs. 26.83 mL (IQR 33.25 mL); p= 0.003) and median LVM (96 g/m2 (IQR 35 g/m2) vs. 90 g/m2 (IQR 29.8 g/m2); p= 0.041) compared to the group of patients who relapsed where we did not observe a significant change in periatrial EAT volume (23.76 mL (IQR 26.84 mL) vs. 31.28 mL (IQR 27.84); p= 0.345) or LVM (117.5 g/m2 (IQR 34 g/m2) vs. 112 g/m2 (IQR 28.6 g/m2); p= 1.0). Significant correlation was observed between BMI and periatrial EAT volume (p= 0.029). Conclusions Restoration of sinus rhythm after CA of AF is associated to lower periatrial EAT volume and LVM. Patients who relapsed did not show reverse cardiac remodelling. Periatrial EAT volume significantly correlates with BMI.