title: Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation.
abstract: OBJECTIVE
  Identifying patients who benefit from restored sinus rhythm (SR) would optimize the selection of candidates for ablation of long-standing persistent atrial fibrillation (LSPAF). This prospective study sought to identify the hitherto unknown factors associated with global functional improvement after successful radiofrequency catheter ablation of LSPAF.
  
  
  RESULTS
  In 171 LSPAF patients (84% of the total consecutive 203 patients) who were examined in SR 12 months after ablation, the individual per cent change from baseline value in maximum oxygen consumption at exercise test (VO2 max), left ventricular ejection fraction (LVEF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five-dimensional descriptive system (EQ-5D) of quality-of-life questionnaire were classified in quartiles by 0 (worse) to 3 (best) grades. The individual grades were summed into a composite score (SCORE, 0 … 12) reflecting global functional improvement. Significant improvement in VO2 max (3.4 ± 4.7 mL/kg/min), LVEF (7.5 ± 9.1%), NT-proBNP (-861 ± 809 pg/mL), and EQ-5D (0.7 ± 0.12) was observed (all P < 0.0001). On multivariable analysis, younger age (P = 0.001), male gender (P = 0.02), timely post-ablation left atrial appendage (LAA) outflow (P = 0.005) with improvement in outflow velocity (P = 0.0002), and withdrawal of Class I/III antiarrhythmic drugs (P < 0.05) were positively and independently correlated with the SCORE.
  
  
  CONCLUSIONS
  Younger male patients benefited most from catheter ablation of LSPAF. Delayed or non-improved LAA outflow and inability to discontinue Class I/III antiarrhythmic medication reduced the post-ablation functional improvement.
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic.|Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Fiala
authors.affiliation: Department of Cardiology and Angiology, St. Anne's University Hospital and International, Clinical Research Centre, Brno, Czech Republic.
authors.forename: Veronika
authors.initials: V
authors.lastname: Bulková
authors.affiliation: Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Šknouril
authors.affiliation: Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic.
authors.forename: Renáta
authors.initials: R
authors.lastname: Nevralová
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Toman
authors.affiliation: Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Januška
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Špinar
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Atrial fibrillation; Catheter ablation; Long-standing persistent; Outcome