Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation

The success rate of catheter ablation of persistent atrial fibrillation (AF) is not satisfactory, for reasons that are unclear. The purpose of this study was to examine the relationship between left atrial reverse remodeling after ablation and recurrence of AF in patients with persistent AF. One hundred and thirty-two patients with persistent AF were enrolled. Extensive encircling pulmonary vein isolation plus ablation of complex fractionated atrial electrograms was performed. Bepridil or amiodarone was prescribed for 3 months after ablation. All patients were studied by serial echocardiography and 24-h ambulatory electrocardiogram at baseline, for the day after ablation, and at 1-, 3-, and 6-month intervals after ablation. Recurrence of AF was observed in 42 patients at 2-year follow-up. The duration of AF (median 12 (IQR 6–37) vs 8 (IQR 5–17) months, p < 0.05), and early recurrence of AF (69 vs 26%, p < 0.05) after ablation were significantly different between the patients with AF recurrence and those without. The left atrial dimensions at 3 months (40 ± 6 vs 44 ± 6 mm, p < 0.001) and 6 months (40 ± 6 vs 44 ± 6 mm, p < 0.001) were significantly smaller than those just after ablation in the patients without AF recurrence. A 5% reduction from baseline in the left atrial dimension at 6 months after ablation was associated with freedom from late AF recurrence (p < 0.05). Left atrial reverse remodeling after ablation of persistent AF was associated with freedom from late recurrence of AF.