Reverse remodelling of the heart after atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

Abstract

Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freedom from AF and left heart reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF). Methods. There were 47 patients (mean age 53.3 ± 10 years, 39 males) enrolled into single-center observational study, with left ventricular ejection fraction (LVEF) <40%. Patients underwent CA for AF refractory to antiarrhythmic drugs. Baseline clinical data and diagnostic tests results were obtained during personal visits and/or via secure telemedical services. Personal contact with evaluation of recurrence of AF and echocardiographic values was performed with 30 (64%) patients. Results. Paroxysmal AF was present in 12 (40%) patients, persistent - in 18 (60%). During mean follow-up of 3 years (0.5-6 years) redo ablation was performed in 9 patients (30%) with average number of 1.3 procedures per patient. At 6 months 24 (80%) patients were free from AF, at last follow-up - 16 (53%). The mean time to first recurrence following CA was 15.6±13.3 months. Follow-up echocardiography revealed significant LVEF improvement (р<0,0001), reduction of left atrium size (р<0,0001), left ventricle end-diastolic volume (р<0,002) and left ventricle end- systolic volume (p<0,0001) and mitral regurgitation (р=0,001). Conclusion. AF CA in patients with HFrEF is associated with improvement in systolic function and left heart reverse remodeling. Durable long-term antiarrhythmic effect often requires repeated procedures.