title: Effect of left ventricular diastolic dysfunction on outcomes of atrial fibrillation ablation.
abstract: Left ventricular diastolic dysfunction (LVDD) is an important pathogenic factor for atrial fibrillation (AF). There are few data on the effect of LVDD on recurrence of AF after catheter ablation. A cohort of 124 patients (59.9 ± 11.7 years, 73.9% male, and 55% with paroxysmal AF) with recalcitrant AF and normal left ventricular systolic function (left ventricular ejection fraction ≥50%) undergoing ablation was studied. Each patient underwent transthoracic echocardiography, and LVDD was meticulously graded using rhythm-independent (AF or sinus rhythm) transmitral and tissue Doppler parameters. Patients underwent catheter ablation of AF using a stepwise protocol. All patients were followed up at 3, 6, and 12 months with recurrent AF (>30 seconds) captured by electrocardiography and/or 7-day monitor. Kaplan-Meier survival analysis and Cox proportional hazards model were used. There was no LVDD in 72 patients (58%), whereas 33 (26.6%), 10 (8.1%), and 9 (7.3%) patients had grades 1, 2, and 3 LVDD, respectively. AF recurred in 49 patients (39.5%) with median time to recurrence of 248 days. Patients with higher grade of LVDD were increasingly more likely to have recurrence (37.5% for no LVDD and 30.3%, 60%, and 66.7% for grades 1, 2, and 3 LVDD, respectively). Significant LVDD (grade 2 or 3) was an independent predictor of recurrence (hazard ratio 2.6, p = 0.009) after adjusting for persistent (vs paroxysmal) AF and left atrial volume. In conclusion, patients with more severe LVDD have a higher risk of AF recurrence after catheter ablation. These patients may derive less benefit from ablation or may require a more extensive ablation approach.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ankit
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: J Paul
authors.initials: JP
authors.lastname: Mounsey
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Chung
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Schwartz
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Irion W
authors.initials: IW
authors.lastname: Pursell
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina. Electronic address: anil_gehi@med.unc.edu.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gehi
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001783:Blood Flow Velocity; D017115:Catheter Ablation; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology