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, therapies for LVDD 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

70 consecutive patients included in prospective AF catheter ablation registry (61±10 years, 66% male) with paroxysmal (n=40) or persistent AF (n=30) were examined by transthoracic echocardiography, before and 12 months after ablation. LVDD was classified according to current guidelines. Rhythm outcome of the ablation was verified by serial 7-day Holter ECG.

RESULTS

LVDD was present in 27 patients (38%) at baseline and in 33 patients (47%) at 12 months follow-up (p=.327). An improvement of LVDD was observed in 13 patients (19%), an aggravation was found in 19 (27%), while it was unchanged in the remaining 38 patients (54%). In uni- and multivariable regression analysis, 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 rhythm during follow-up influenced LVDD alterations. There was no association between echocardiographic deterioration and symptoms.

CONCLUSIONS

Catheter ablation of AF can worsen LVDD in a substantial proportion of patients with more aggressive ablation leading to aggravation of LVDD. While there are no apparent negative short-term effects, long-term consequences need to be determined.