title: Impact of atrial fibrillation ablation on left ventricular filling pressure and left atrial remodeling.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process.
  
  
  OBJECTIVE
  To evaluate the impact of AF ablation on estimated LV filling pressure.
  
  
  METHODS
  A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation.
  
  
  RESULTS
  One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m(2) ± 10.6 mL/m(2) to 22.6 mL/m(2) ± 1.1 mL/m(2), p < 0.001) compared to the non-successful group (37.7 mL/m(2) ± 14.3 mL/m(2) to 37.5 mL/m(2) ± 14.5 mL/m(2), p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001).
  
  
  CONCLUSIONS
  Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Simone Nascimento dos
authors.initials: SN
authors.lastname: Santos
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Benhur Davi
authors.initials: BD
authors.lastname: Henz
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: André Rodrigues
authors.initials: AR
authors.lastname: Zanatta
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Barreto
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Kelly Bianca
authors.initials: KB
authors.lastname: Loureiro
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Novakoski
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Marcus Vinícius Nascimento dos
authors.initials: MV
authors.lastname: Santos
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Fabio F
authors.initials: FF
authors.lastname: Giuseppin
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Edna Maria
authors.initials: EM
authors.lastname: Oliveira
authors.affiliation: Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
authors.forename: Luiz Roberto
authors.initials: LR
authors.lastname: Leite
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D064752:Atrial Remodeling / Q000502:physiology*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*