Left atrial reverse remodeling in patients with persistent atrial fibrillation and HFpEF following radiofrequency ablation: prospective evaluation with echocardiographic atrial analysis.

Objective: This study aimed to assess the extent of Left Atrial (LA) structural and functional reverse remodeling following Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation (AF) in patients with persistent AF and Heart Failure with preserved Ejection Fraction (HFpEF).

Methods: A cohort study was performed following the STROBE Statement. Thirty consecutive HFpEF patients with persistent AF were prospectively enrolled and planned for RFCA. Prior to the procedure, transthoracic echocardiography was performed to assess LA structure, LA strain, and LA contractile function. The same evaluation of LA structure and functional parameters was performed post-ablation at discharge, 1-month, 3-months, 6-months, and 12-months. Baseline data was compared between patients with AF recurrence and non-recurrence post-ablation.

Results: Among the 30 enrolled patients, 4 patients experienced AF recurrence after 3-months, and 7 were lost to follow-up due to the COVID-19 pandemic. Nineteen patients completed the 12-month follow-up without AF recurrence. Structural reverse remodeling was observed in patients without recurrent AF post-ablation, measured by a significant reduction in LA diameters and volumes. LA reservoir Strain (LASres) showed significant improvement at 1-month follow-up, in parallel with the recovery and improvement in LA contractile Strain (LASct). Greater improvement in LA contractile function evaluated via echocardiographic LA imaging parameters was seen in patients who maintained sinus rhythm following ablation.

Conclusion: In patients with persistent AF and HFpEF, RFCA for AF with resultant preservation of sinus rhythm results in the reversal of LA morphological remodeling and notable improvements in LA reservoir and contractile function.