Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging

Lutomsky, Boris; Rostock, Thomas; Koops, A.; Steven, Daniel; Müllerleile, Kai; Servatius, Helge; Drewitz, Imke; Ueberschär, D.; Plagemann, Thorsten; Ventura, Rodolfo; Meinertz, Thomas; Willems, Stephan

doi:10.1093/europace/eun076

Cited by 80 publications

(37 citation statements)

References 22 publications

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“…Moreover, among the patients with paroxysmal AF and systolic left ventricular dysfunction, the PV isolation procedure was followed by a significant rise of EF from 41% to 51% [116]. These findings confirm that not only prolonged episodes of persistent AF, but also frequent attacks of paroxysmal AF can lead to development of reversible tachy-cardiomyopathy.…”

Section: Progression Of Afsupporting

confidence: 65%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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Section: Progression Of Afsupporting

confidence: 65%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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“…[8][9][10][11][12] This has prompted studies investigating whether a rhythm control strategy using catheter ablation might improve outcomes for patients with AF and HF. [13][14][15][16][17][18][19][20] To date these studies have had mixed results, and the number of randomized studies remains small. [18][19][20] We hypothesized that restoring sinus rhythm by catheter ablation improves left ventricular (LV) function and HF symptoms compared with a medical rate control strategy in patients with persistent AF and HF.…”

Section: Clinical Perspective On P 38mentioning

confidence: 99%

A Randomized Controlled Trial of Catheter Ablation Versus Medical Treatment of Atrial Fibrillation in Heart Failure (The CAMTAF Trial)

Hunter

Berriman

Diab

et al. 2014

Circ: Arrhythmia and Electrophysiology

436

382

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Background-Restoring sinus rhythm in patients with heart failure (HF) and atrial fibrillation (AF) may improve left ventricular (LV) function and HF symptoms. We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF. Methods and Results-Patients with persistent AF, symptomatic HF, and LV ejection fraction <50% were randomized to catheter ablation or medical rate control. The primary end-point was the difference between groups in LV ejection fraction at 6 months. Baseline LV ejection fraction was 32±8% in the ablation group and 34±12% in the medical group. Twentysix patients underwent catheter ablation, and 24 patients were rate controlled. Freedom from AF was achieved in 21/26 (81%) at 6 months off antiarrhythmic drugs. LV ejection fraction at 6 months in the ablation group was 40±12% compared with 31±13% in the rate control group (P=0.015

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“…4 -6 In patients with preserved systolic function, however, studies have failed to demonstrate a change in LV ejection fraction after catheter ablation. 7 It is likely however, that LV ejection fraction does not reflect subtle changes in systolic LV function, and therefore the effect of catheter ablation on LV systolic function cannot be detected by measuring LV ejection fraction. Recently, 2D speckle tracking strain imaging has been introduced.…”

Section: Clinical Perspective On P 257mentioning

confidence: 99%

“…It was concluded that successful catheter ablation may be less beneficial in patients with normal LV ejection fraction. 7 However, it may well be that the positive effects of the restoration of sinus rhythm on LV systolic function are present but cannot be detected by conventional parameters such as LV ejection fraction. The evaluation of LV strain may detect more subtle abnormalities in LV systolic function, 20 which can improve after AF ablation.…”

Section: Left Ventricular Function After Catheter Ablationmentioning

confidence: 99%

Long-Term Improvement in Left Ventricular Strain After Successful Catheter Ablation for Atrial Fibrillation in Patients With Preserved Left Ventricular Systolic Function

Tops

Uijl

Delgado

et al. 2009

Circ: Arrhythmia and Electrophysiology

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Background-The effect of successful catheter ablation on left ventricular (LV) strain in patients with preserved LV systolic function is unknown. The aim of the present study was to assess the long-term effects of catheter ablation for atrial fibrillation (AF) on LV strain and strain rate in patients with preserved LV ejection fraction. Methods and Results-In 78 patients undergoing catheter ablation for AF, speckle tracking strain imaging was performed to assess LV strain in 3 directions (radial, circumferential, and longitudinal) at baseline and after 12-month follow-up. The study population was divided into 2 groups, according to the maintenance of sinus rhythm (SR) during follow-up. After 13.8Ϯ4.7 months of follow-up, 54 patients (69%) were in SR (SR group), whereas 24 patients (31%) had recurrence of AF (AF group). No significant changes in LV ejection fraction from baseline to follow-up were noted (60Ϯ7% versus 59Ϯ7%, PϭNS). Circumferential strain improved significantly in the SR group (Ϫ18.3Ϯ3.2% versus Ϫ20.4Ϯ3.8%, PϽ0.001), whereas it remained unchanged in the AF group (Ϫ18.9Ϯ3.5% versus Ϫ17.9Ϯ3.1%, PϭNS). In the SR group, significant improvements in LV longitudinal strain and strain rate were noted, whereas in the AF group, LV longitudinal strain and strain rate deteriorated significantly at long-term follow-up. Conclusions-After successful catheter ablation, LV circumferential and longitudinal strain and strain rate improve significantly in patients who maintain SR. In contrast, a decrease in LV longitudinal strain and strain rate is observed in patients with recurrence of AF. (Circ Arrhythmia Electrophysiol. 2009;2:249-257.)

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Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging

Abstract: Pulmonary vein isolation improves cardiac function in patients with paroxysmal AF and impaired LVEF. These data suggest that an impaired LV function can be partially attributed to AF with short-lasting paroxysms.

Cited by 80 publications

References 22 publications

Catheter Ablation of Lone Atrial Fibrillation

Catheter Ablation of Lone Atrial Fibrillation

A Randomized Controlled Trial of Catheter Ablation Versus Medical Treatment of Atrial Fibrillation in Heart Failure (The CAMTAF Trial)

Long-Term Improvement in Left Ventricular Strain After Successful Catheter Ablation for Atrial Fibrillation in Patients With Preserved Left Ventricular Systolic Function

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