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Background <p>Atrial fibrillation (AF) is associated with adverse&#xa0;remodeling of the left atrium (LA). The impact of the extent of atrial myopathy and post-ablation remodeling on quality-of-life (QoL) outcomes has not&#xa0;been studied.</p> Objective <p>The aim of our study was to investigate the association between atrial myopathy and post-ablation remodeling on quality-of-life outcomes in patients with persistent AF.</p> Methods <p>We conducted an analysis of DECAAF II participants who underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. We assessed&#xa0;atrial myopathy and post-ablation atrial remodeling, scar formation, and fibrosis coverage with ablation. QoL metrics were assessed using the Short Form Survey (SF-36) and Atrial Fibrillation Severity Scale (AFSS). Uni- and multivariable regression models were developed for this analysis.</p> Results <p>Six hundred thirteen patients with persistent AF were included in our analyses. At baseline, AFSS burden and total AFSS score were 18.94 ± 7.35 and 12.24 ± 8.17, respectively. Following ablation, all QoL and AFSS metrics improved in both the pulmonary vein isolation (PVI) and MRI-guided fibrosis ablation groups. On average, one unit of post-ablation reduction in left atrial volume index (LAVI) was associated with an improvement of 0.085 in total AFSS score (<i>p</i> = 0.001), 0.01 in shortness of breath with activity (<i>p</i> &lt; 0.001), 0.15 in AF burden (<i>p</i> &lt; 0.001), − 0.016 in global well-being (<i>p</i> = 0.018), 0.519 in health change (<i>p</i> &lt; 0.001), 0.19 in vitality (vitality (<i>p</i> = 0.01), and 0.27 in physical functioning (<i>p</i> = 0.001). Baseline fibrosis and residual fibrosis post-ablation were associated with improved vitality and general health.</p> Conclusion <p>Atrial myopathy and post-ablation atrial remodeling significantly impact QoL in patients with persistent AF undergoing ablation.</p> Graphical abstract <p></p>

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Impact of left atrial myopathy and post-ablation remodeling on quality of life: a DECAAF II sub-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月3日

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  • Ghassan Bidaoui,
  • Han Feng,
  • Nour Chouman,
  • Ala Assaf,
  • Chanho Lim,
  • Hadi Younes,
  • Mayana Bsoul,
  • Christian Massad,
  • Francisco Tirado Polo,
  • Yishi Jia,
  • Yingshou Liu,
  • Abboud Hassan,
  • William Rittmeyer,
  • Mario Mekhael,
  • Charbel Noujaim,
  • Amitabh C. Pandey,
  • Swati Rao,
  • Omar Kreidieh,
  • Nassir F. Marrouche,
  • Eoin Donnellan

摘要

Background

Atrial fibrillation (AF) is associated with adverse remodeling of the left atrium (LA). The impact of the extent of atrial myopathy and post-ablation remodeling on quality-of-life (QoL) outcomes has not been studied.

Objective

The aim of our study was to investigate the association between atrial myopathy and post-ablation remodeling on quality-of-life outcomes in patients with persistent AF.

Methods

We conducted an analysis of DECAAF II participants who underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. We assessed atrial myopathy and post-ablation atrial remodeling, scar formation, and fibrosis coverage with ablation. QoL metrics were assessed using the Short Form Survey (SF-36) and Atrial Fibrillation Severity Scale (AFSS). Uni- and multivariable regression models were developed for this analysis.

Results

Six hundred thirteen patients with persistent AF were included in our analyses. At baseline, AFSS burden and total AFSS score were 18.94 ± 7.35 and 12.24 ± 8.17, respectively. Following ablation, all QoL and AFSS metrics improved in both the pulmonary vein isolation (PVI) and MRI-guided fibrosis ablation groups. On average, one unit of post-ablation reduction in left atrial volume index (LAVI) was associated with an improvement of 0.085 in total AFSS score (p = 0.001), 0.01 in shortness of breath with activity (p < 0.001), 0.15 in AF burden (p < 0.001), − 0.016 in global well-being (p = 0.018), 0.519 in health change (p < 0.001), 0.19 in vitality (vitality (p = 0.01), and 0.27 in physical functioning (p = 0.001). Baseline fibrosis and residual fibrosis post-ablation were associated with improved vitality and general health.

Conclusion

Atrial myopathy and post-ablation atrial remodeling significantly impact QoL in patients with persistent AF undergoing ablation.

Graphical abstract