Echocardiography. 2026 Oct;43(10):e70646. doi: 10.1111/echo.70646.
ABSTRACT
PURPOSE: Evidence regarding left atrial (LA) remodeling with pharmacological rhythm control remains limited, particularly in patients with atrial fibrillation (AF) outside heart-failure-specific populations.
METHODS: This single-center retrospective cohort included 156 adults with paroxysmal or persistent AF receiving mutually exclusive pharmacological rate-control (n = 92) or rhythm-control (n = 64) therapy who underwent two transthoracic echocardiograms. LA remodeling was assessed using serial echocardiography, and clinical outcomes were evaluated after the second examination.
RESULTS: Among 74 patients with paired left atrial volume index (LAVI) measurements, LAVI increased from 39.9 to 50.3 mL/m2 with rate control (p < 0.001) but remained unchanged with rhythm control (44.9 to 43.4 mL/m2; p = 0.465). After adjustment for baseline LAVI and clinical covariates, rhythm control was associated with a 9.38 mL/m2 lower follow-up LAVI (95% CI, -15.53 to -3.24; p = 0.003). The association with lower follow-up LAVI was also observed among patients without heart failure and remained similar in sensitivity analyses. During post-landmark follow-up, rhythm control was associated with a lower hazard of all-cause mortality or stroke hospitalization (adjusted HR, 0.46; 95% CI, 0.24-0.88; p = 0.019).
CONCLUSION: Pharmacological rhythm control was associated with more favorable longitudinal LA remodeling than rate control, including among patients without heart failure, and was also associated with a lower hazard of subsequent all-cause mortality or stroke hospitalization.
PMID:42859965 | DOI:10.1111/echo.70646