title: Changes in left ventricular filling parameters following catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common in the setting of abnormal ventricular relaxation. We evaluated the association between ventricular relaxation grade and atrial fibrosis and examined the change in left ventricular filling parameters following catheter ablation.
  
  
  RESULTS
  AF patients undergoing catheter ablation who had cardiac late gadolinium enhancement MRI (LGE-MRI) and echocardiographic examinations were included in the study. Left atrial (LA) tissue fibrosis and volume were quantified using LGE-MRI. Echocardiograms were performed at baseline and 3 months following catheter ablation to assess left ventricular (LV) filling. Two hundred and ninety three patients (60.8 % male) met the inclusion criteria. In patients in sinus rhythm at baseline (n = 115), ventricular relaxation pattern was identified as normal in 54 patients (47.0 %), impaired in 35 (30.4 %), pseudo-normal in 18 (15.7 %), and restrictive in 8 (7.0 %). Restrictive LV filling was associated with higher LA volume index (61.2 ± 30.5 vs 46.0 ± 18.5 ml/m2; p < 0.01) and LA fibrosis (21.8 ± 10.9 % vs 15.5 ± 9.4 %; p = 0.036) compared to non-restrictive filling. In patients in sinus rhythm on both pre- and post-ablation echocardiograms (n = 104), A waves decreased from 0.70 ± 0.23 at baseline to 0.60 ± 0.20 (p < 0.01) and E/E' decreased from 9.6 ± 4.0 at baseline to 8.6 ± 3.5 (p = 0.03). Thirty-two patients (27.2 %) had an improvement, and 24 patients (23.1 %) had a worsening in diastolic grade. Clinical heart failure and diabetes were associated with worse diastolic grade post-ablation.
  
  
  CONCLUSIONS
  Restrictive LV filling is associated with higher LA fibrosis. A change in echocardiographic LV filling pattern was noted in over 50 % of patients post-ablation.
authors.affiliation: Rocky Mountain Heart and Lung, Kalispell, MT, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Krezowski
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Brent D
authors.initials: BD
authors.lastname: Wilson
authors.affiliation: Swedish Heart and Vascular, Seattle, WA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McGann
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.affiliation: Division of Cardiology, University of Washington, Seattle, WA, USA. nakoum@cardiology.washington.edu.|, 1959 NE Pacific Street, Box 356171, Seattle, WA, 98195, USA. nakoum@cardiology.washington.edu.
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology*
keywords: Atrial fibrillation; Catheter ablation; Ventricular relaxation