JHLT Open · Published 2026-07-03 · DOI 10.1016/j.jhlto.2026.100624
Daisuke Yakabe, Kazuo Sakamoto, Komei Mizokami, Tsukasa Watanabe, Hirotake Yokoyama, Sayana Kuraoka, Kayo Misumi, Tomomi Nagayama, Keisuke Shinohara, Takeo Fujino, Toru Hashimoto, Shouji Matsushima, Akira Shiose, Kohtaro Abe
Background: The clinical impact of atrial fibrillation (AF) in patients undergoing left ventricular assist device (LVAD) implantation remains uncertain, particularly regarding whether the post-LVAD rhythm status carries prognostic value. Methods: We retrospectively reviewed consecutive LVAD recipients at our institution between 2008 and 2023. Patients were categorized as no AF, new-onset AF, resolved AF, or recurrent AF according to rhythm status before and after implantation. The primary endpoint was hospitalization for heart failure, and the secondary endpoints were all-cause death, stroke, and major bleeding. Left atrial (LA) reverse remodeling was quantified as the percent reduction in LA diameter. Results: Among 115 patients (mean age 46 years; 69.6% male; 14.8% ischemic etiology), 44 (38.3%) had AF before implantation. Over a median follow-up of 50.8 months, 29 of 44 patients (65.9%) had no AF recurrence by 3 months after implantation (resolved AF group), whereas 15 had AF (recurrent AF group); among the 71 patients without pre-LVAD AF, three developed new-onset AF. Compared with the recurrent AF group, the resolved AF group had a significantly lower risk of heart failure hospitalization (hazard ratio, 0.25; 95% confidence interval, 0.07–0.86; P = 0.027). LA diameter decreased to a greater extent in the resolved AF group than in the recurrent AF group (LA reduction rate: 24.5% vs. 10.8%; P = 0.032). Conclusions: LVAD implantation was associated with LA reduction through reverse remodeling and led to AF resolution in a subset of patients. Patients with AF resolution experienced fewer heart failure events during LVAD support.
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Yakabe, D., Sakamoto, K., Mizokami, K., et al. (2026). Prognostic significance of atrial fibrillation resolution after left ventricular assist device implantation. JHLT Open. https://doi.org/10.1016/j.jhlto.2026.100624