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Observational Study
. 2022 Mar 15;79(10):951-961.
doi: 10.1016/j.jacc.2021.12.029.

Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation

Laurie Soulat-Dufour  1 , Sylvie Lang  2 , Karima Addetia  3 , Stephane Ederhy  2 , Saroumadi Adavane-Scheuble  2 , Marion Chauvet-Droit  2 , Marie-Liesse Jean  2 , Pascal Nhan  2 , Rim Ben Said  2 , Iris Kamami  2 , Pauline Issaurat  2 , Elodie Capderou  2 , Camille Arnaud  2 , Franck Boccara  4 , Roberto M Lang  3 , Ariel Cohen  5
Affiliations
Observational Study

Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation

Laurie Soulat-Dufour et al. J Am Coll Cardiol. .

Abstract

Background: Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation.

Objectives: The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months.

Methods: A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations).

Results: During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P < 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P < 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P < 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up.

Conclusions: Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).

Keywords: 3-dimensional echocardiography; ablation; atrial fibrillation; cardiac remodeling; cardioversion; functional regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures This work was partially funded by Bayer and the Fondation de France. Dr Soulat-Dufour has received a grant from Fédération Française de Cardiologie. Dr Cohen has received research grants from RESICARD (research nurses) and from ARS, Bayer, and Boehringer Ingelheim; and has received consultant and lecture fees from AstraZeneca, Bayer Pharma, Bristol Myers Squibb-Pfizer Alliance, Boehringer Ingelheim, Daiichi-Sankyo, and Novartis, unrelated to the present work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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