Arrhythmias & electrophysiology
Early Remodeling of the Left Atrium Following Catheter Ablation of Atrial Fibrillation: Insights From DECAAFII
Authors' conclusion
We confirmed the presence of LA remodeling within 3 months after ablation for persistent AF. Importantly, we saw more LA volume reductions in patients in the PVI + fibrosis-guided ablation arm in comparison with PVI only, and in patients with LV dysfunction. LA volume reduction in response to CA is associated with decreased arrhythmia recurrence, reduced AF burden, and improved LVEF and quality of life.
Study context
- Population
- Patients with persistent atrial fibrillation (AF) undergoing catheter ablation
- Participants
- 733 patients
- Comparison
- Pulmonary vein isolation (PVI) + fibrosis-guided ablation vs PVI only
- Primary endpoint
- Early left atrial (LA) remodeling (LA volume index change on LGE-MRI)
- Follow-up
- 3 months after CA
Methodological detailsLate gadolinium enhancement magnetic resonance imaging (LGE-MRI) before and 3 months after CA; single-lead ECG follow-up for 12 to18 months
- LGE-MRI before and 3 months after CA; single-lead ECG follow-up for 12 to18 months
Primary result
As reported in the abstract
LAVI reduction · 3 months
P = 0.02
mm³/m²
- Mean LA volume index (LAVI) before ablation
- 62.0
- Mean LAVI after ablation
- 51.3
- Mean LAVI reduction (overall)
- 10.7 (P < 0.001)
Further findings
| Outcome | HF | No HF | P value |
|---|---|---|---|
| LAVI reduction, HF vs no HF (subgroup) | 15.7 | 8.9 | P = 0.001 |
Correlates of LAVI reduction
- Improved left ventricular ejection fraction (LVEF)
- r = 0.23; P < 0.001
- Reduced AF burden
- r = −0.173; P < 0.001
- Improved quality of life
- r = 0.146; P < 0.001
Original publication
Early Remodeling of the Left Atrium Following Catheter Ablation of Atrial Fibrillation: Insights From DECAAFII. JACC Clin Electrophysiol. Published 20 September 2023. doi:10.
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