The following is a summary of “Association of Atrial Fibrillation Progression With Left Atrial Functional Reserve and Its Reversibility,” published in the December 2023 issue of Cardiology by Hirose et al.

In this prospective study, researchers explored the association between AF progression and heart failure prevention in this prospective study involving 164 patients with atrial fibrillation (AF) and normal left ventricular systolic function without heart failure who underwent initial catheter ablation with pre- and postprocedural echocardiography. Emphasizing the significance of left atrial (LA) function and functional reserve in the pathogenesis connecting AF and heart failure, the study group utilized conventional and speckle-tracking echocardiography during rest and passive leg lifting to assess LA size, LA reservoir strain (LARS), and functional reserve calculated as passive leg lifting-LARS – rest-LARS. Patients were categorized into three AF subtypes: paroxysmal AF (N=95), persistent AF (PeAF; N=50), and long-standing persistent AF (LS-PeAF; N=19). The PeAF and LS-PeAF groups exhibited larger LA size and reduced LARS than the paroxysmal AF group (all P<0.05). 

Notably, LA functional reserve was significantly impaired in the LS-PeAF group (P=0.003). In multivariable analysis, LS-PeAF and advanced age were significantly associated with impaired LA functional reserve. Among 149 patients with sinus rhythm 1 to 2 days post-catheter ablation, LARS showed significant improvement in both PeAF and LS-PeAF groups but remained lower than in the paroxysmal AF group. The restoration of sinus rhythm also contributed to the amelioration of LA functional reserve in patients with LS-PeAF. The investigator’s findings underscore the relationship between AF progression and compromised LARS and LA functional reserve, suggesting that the reinstatement of sinus rhythm may play a crucial role in early LA reverse remodeling. These results contribute to a better understanding of the intricate interplay between AF and heart failure, offering potential insights for targeted interventions in clinical practice.

Source: ahajournals.org/doi/10.1161/JAHA.123.032215