title: Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function.
abstract: BACKGROUND
  The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain.
  
  
  RESULTS
  A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; and 100 patients with normal LV function. The primary end point was AAD-free AF elimination at 1 year after ablation. This end point was achieved in 62% of patients with systolic dysfunction, 75% of those with diastolic dysfunction, and 84% of controls (P=0.007). AF control on or off AADs was achieved in 76% of patients with systolic dysfunction, 85% of those with diastolic dysfunction, and 89% of controls (P=0.08). In the systolic dysfunction group, 49% experienced an increase in LVEF by ≥5% after ablation, of which 64% achieved normal LVEF. In the diastolic dysfunction group, 30% of patients demonstrated at least 1 grade improvement in diastolic dysfunction. Multivariable analysis demonstrated an increased relative risk of arrhythmia recurrence of 1.8 (95% CI, 1.1 to 3.1; P=0.02) in systolic dysfunction and 1.7 (1.0 to 2.7; P=0.04) in isolated diastolic dysfunction compared with normal function.
  
  
  CONCLUSIONS
  Although an ablative approach for AF in patients with systolic or diastolic dysfunction is associated with an increased long-term recurrence risk, there is potential for substantial quality-of-life improvement and LV functional benefit.
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. ycha@mayo.edu
authors: Yong-Mei
authors: YM
authors: Cha
authors: Anita
authors: A
authors: Wokhlu
authors: Samuel J
authors: SJ
authors: Asirvatham
authors: Win-Kuang
authors: WK
authors: Shen
authors: Paul A
authors: PA
authors: Friedman
authors: Thomas M
authors: TM
authors: Munger
authors: Jae K
authors: JK
authors: Oh
authors: Kristi H
authors: KH
authors: Monahan
authors: Janis M
authors: JM
authors: Haroldson
authors: David O
authors: DO
authors: Hodge
authors: Regina M
authors: RM
authors: Herges
authors: Stephen C
authors: SC
authors: Hammill
authors: Douglas L
authors: DL
authors: Packer
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D015897:Comorbidity; D003971:Diastole / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*