Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation

Abstract

Background Maintenance of sinus rhythm after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with left atrial (LA) and ventricular (LV) reverse remodeling, although the degree varies among individuals. We hypothesized that frequent premature atrial complex (PAC) after PVI may attenuate the left heart reverse remodeling benefited from maintenance of sinus rhythm. Methods We included 82 AF patients who underwent first‐time PVI and 24‐h Holter recordings at 6 months after PVI. All patients had no AF recurrence before this time. The number of PAC was categorized into tertiles: <90, 90‐488 and >488 PACs/day. All patients underwent two‐dimensional echocardiography and serum plasma B‐type natriuretic peptide (BNP) measurement before and 6 months after PVI. LA reverse remodeling was defined as ≥15% decrease in LA volume index. Results There was no significant difference in the baseline characteristics among the PAC tertiles except for sex. Six months after PVI, LA volume index, LV mass index, and serum BNP levels were significantly decreased in lower and middle PAC tertiles (all P < .05), whereas no significant changes were observed in upper PAC tertile. Frequency of LA reverse remodeling was significantly lower in upper tertile of PAC compared with middle and lower tertiles (22.2%, 57.1%, and 59.3%, P < .001). Baseline LA volume index, changes in LV mass index, and the frequency of PAC were independently associated with LA reverse remodeling (all P < .05). Conclusions Frequent PAC after PVI was associated with less left heart reverse remodeling in AF patients even without AF recurrence.

Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy

“…PAC occurrence is associated with LA dilation and risk factors for atrial cardiomyopathy in an ESUS population ( Pinho et al, 2015 ; Vinther et al, 2017 ; Cha et al, 2020 ), suggesting that PACs are a clinical marker of atrial cardiomyopathy ( Sajeev et al, 2019 ). Furthermore, the presence of PACs after AF ablation results in a significant decrease in left atrial reverse remodeling ( Hasegawa et al, 2019 ), highlighting a direct role of PACs in atrial cardiomyopathy.…”