Abstract 15089: Effect of Left Ventricular Diastolic Dysfunction on Outcomes of Atrial Fibrillation Ablation
Background: Left ventricular diastolic dysfunction (LVDD) is an important pathogenic factor for atrial fibrillation (AF). There is a little data on the effect of LVDD on recurrence of AF after catheter ablation.
Methods: A cohort of 124 patients with drug-resistant AF and normal LV systolic function (LVEF ≥ 50%) undergoing ablation was included in the study. Each patient underwent TTE and LVDD was meticulously graded from 0 to 3 using trans-mitral and tissue Doppler parameters, irrespective of whether the patient was in AF. Patients underwent catheter ablation of AF using a step-wise protocol. All patients were followed at 3, 6, and 12 months with recurrent AF (>30 sec) captured by EKG and/or 7-day monitor. Kaplan-Meier survival analysis and Cox proportional hazards model were used.
Results: Mean age of the cohort was 59.8 (11.6) years, 74.2% were male, and 55% had paroxysmal AF. LVDD was not present in 72 (58%) of patients, while 33 (26.6%), 10 (8.1%), and 9 (7.3%) of patients had grade 1, 2, or 3 LVDD respectively. AF recurred in 23 (18.5%) of patients with median time to recurrence of 157 days. Comparing grade 2/3 LVDD (15%) to grade 0/1 (85%), significant LVDD was an independent predictor of recurrence (HR 4.4, p=0.001, Figure). This risk of LVDD was significant (HR 3.8, p=0.005) even after adjusting for multiple potential covariates including persistent (vs. paroxysmal) AF, LA volume, use of antiarrhythmic medications beyond 3 months after catheter ablation and AF duration.
Conclusion: Patients with more severe LVDD have a higher risk of AF recurrence after catheter ablation. These patients may derive less benefit from ablation or may require a more extensive ablation approach.
- © 2013 by American Heart Association, Inc.