Success of Ablation for Atrial Fibrillation in Isolated Left Ventricular Diastolic Dysfunction

Abstract

Background-The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain. Methods and Results-A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) Յ40%; 157 patients with isolated diastolic dysfunction but preserved LVEF Ն50%; and 100 patients with normal LV function. The primary end point was AAD-free AF elimination at 1 year after ablation. This end point was achieved in 62% of patients with systolic dysfunction, 75% of those with diastolic dysfunction, and 84% of controls (Pϭ0.007). AF control on or off AADs was achieved in 76% of patients with systolic dysfunction, 85% of those with diastolic dysfunction, and 89% of controls (Pϭ0.08).In the systolic dysfunction group, 49% experienced an increase in LVEF by Ն5% after ablation, of which 64% achieved normal LVEF. In the diastolic dysfunction group, 30% of patients demonstrated at least 1 grade improvement in diastolic dysfunction. Multivariable analysis demonstrated an increased relative risk of arrhythmia recurrence of 1.8 (95% CI, 1.1 to 3.1; Pϭ0.02) in systolic dysfunction and 1.7 (1.0 to 2.7; Pϭ0.04) in isolated diastolic dysfunction compared with normal function. Conclusions-Although an ablative approach for AF in patients with systolic or diastolic dysfunction is associated with an increased long-term recurrence risk, there is potential for substantial quality-of-life improvement and LV functional benefit. (Circ Arrhythm Electrophysiol. 2011;4:724-732.)

Diastolic Echocardiographic Parameters in Predicting Outcome of Radiofrequency Catheter Ablation of Atrial Fibrillation

“…Unlike many other diastolic measurements, which are affected by AF, the E/e' ratio can be measured also during AF [22]. In keeping with our data, results of some previous studies indicate that diastolic dysfunction or heart failure predicts AF recurrence after ablation [23][24][25][26]. It has been shown that LV diastolic dysfunction may promote AF [27].…”

Effects of Iatrogenic Myocardial Injury on Coronary Microvascular Function in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation

“…This result might indicate that impairment of myocardial blood supply caused by coronary microvascular dysfunction makes an important contribution to LV diastolic dysfunction. Furthermore, because LV diastolic dysfunction plays a prominent role in creating an arrhythmogenic substrate, 18,19 our original findings present a plausible mechanism for early recurrence during the blanking period.…”

Impact of Left Ventricular Diastolic Dysfunction on Outcome of Catheter Ablation for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

“…8,18,19 In contrast, SR was maintained in 13 of 16 patients (82%) with mild or moderate LV diastolic dysfunction (E/e' <15). In those patients, the LA pressure might not be so high and the LA remodeling might not progress very much after RFCA for AF.…”