Atrial fibrillation is associated with left ventricular dysfunction and impaired myocardial energetics that persist despite catheter ablation: Is atrial fibrillation the chicken or the egg?

Atrial fibrillation (AF) is associated with increased risk of heart failure and premature death, and is often resistant to treatment. Animal models of pacing-induced AF indicate that AF-induced endothelial dysfunction, impaired coronary reserve, and myocardial remodelling are important in arrhythmia maintenance. However, human AF may reflect a subclinical cardiomyopathy, which persists after sinus rhythm (SR) restoration and provides a substrate for AF recurrence. To test this hypothesis, we investigated the effect of restoring SR by catheter ablation on left ventricular (LV) function and energetics.