Abstract 16982: Prevalence and Predictors of Worsened Left Ventricular Diastolic Dysfunction After Catheter Ablation of Atrial Fibrillation
Background: The interactions between atrial fibrillation (AF) and left ventricular diastolic dysfunction (LVDD) are complex and not well defined. Despite the high prevalence of LVDD in the AF population, LVDD therapies remain limited. Previous studies have suggested that restoration of sinus rhythm with catheter ablation has a positive effect on LVDD, but the prevalence and predictors for worsened LVDD are unknown.
Methods: Of 392 consecutive patients included in our prospective AF catheter ablation registry, 70 patients (mean age 61 ± 10 years, 34 % male) with paroxysmal (n=40) or persistent AF (n=30) were examined by transthoracic echocardiography during sinus rhythm, before and 12 months after ablation. Mitral early diastolic peak (E wave) and late peak (A wave) velocities, E/A ratio, deceleration time (DT) of mitral early velocity, early diastolic mitral annulus peak velocity (e) and E/e ratio were determined. The outcome of the ablation was verified by 7-day Holter ECG directly after catheter ablation and after 6 and 12 months.
Results: LVDD was initially present in 27 patients (38 %) and in 33 patients (47%) at 12 months follow-up (p=n.s.). An improvement of LVDD defined as transition to lower stage defined by current guidelines was observed in 13 patients (19%), an aggravation was found in 19 (27%) while it was unchanged in the remaining 54 %. In uni- and multivariable regression analysis, the total ablation time (OR 1.611 per 10 min ablation time, 95 % CI 1.088 - 2.386, p=.017) was associated with LVDD progression, while neither baseline characteristics nor ablation outcome influenced LVDD alterations. There was no association between echocardiographic deterioration and symptoms.
Conclusions: Catheter ablation of AF can significantly influence LVDD with more aggressive ablation leading to aggravation of LVDD in a substantial proportion of patients. While there are no apparent negative short-term effects, long-term consequences need to be determined.
- © 2012 by American Heart Association, Inc.