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

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.