title: The ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em) predicts improvement in left ventricular systolic and diastolic function 1 year after catheter ablation for atrial fibrillation.
abstract: OBJECTIVE
  Successful rhythm control after atrial fibrillation catheter ablation is known to induce left atrial reverse remodelling and improve left ventricular (LV) function. We explored the clinical factors affecting LV systolic and diastolic function 1-year after catheter ablation for atrial fibrillation.
  
  
  RESULTS
  We compared pre-procedural and 1-year follow-up echocardiograms in 521 patients with atrial fibrillation who underwent catheter ablation. Left ventricular systolic function was estimated by the ejection fraction (EF); diastolic function was estimated by the ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em). (i) Catheter ablation of atrial fibrillation significantly reduced left atrium volume index (P < 0.001) and improved LV EF both in patients with recurrent atrial fibrillation (n = 133, P = 0.008) and those without recurrence (n = 388, P < 0.001). (ii) Follow-up EF was significantly improved in patients with baseline E/Em < 15 (n = 454, P < 0.001), whereas E/Em was significantly reduced in patients with pre-procedural E/Em ≥ 15 (n = 67, P = 0.008). (iii) Baseline E/Em < 15 (β = -3.854, 95% CI -5.99 to -1.72, P < 0.001), baseline EF <50% (β = 10.586, 95% CI 7.55 to 13.63, P < 0.001), and female (β = -1.726, 95% CI -3.36 to -0.10, P = 0.038) were independently associated with improved EF. Baseline E/Em ≥ 15 (β = 4.896, 95% CI 3.45 to 6.34, P < 0.001) and younger age (β = -0.066, 95% CI -0.11 to -0.02, P = 0.003) were independent factors associated with improved E/Em.
  
  
  CONCLUSIONS
  Pre-procedural E/Em predicted improvement in LV systolic and diastolic functions 1 year after catheter ablation for atrial fibrillation. Low baseline E/Em was independently associated with improved EF, while high E/Em predicted improvement in LV diastolic function.
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: In-Soo
authors.initials: IS
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Hee-Sun
authors.initials: HS
authors.lastname: Mun
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Jae Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001783:Blood Flow Velocity; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*
keywords: Atrial fibrillation; Catheter ablation; Diastolic function; Early mitral annular velocity; Early transmitral flow velocity; Systolic function