Abstract 4144388: Impact of Left Atrial Myopathy and Post-Ablation Remodeling on Quality of Life: A DECAAF II Subanalysis

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 have 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: 613 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.