Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
Int J Cardiol. 2013 Oct 9;168(4):3613-5. doi: 10.1016/j.ijcard.2013.05.047. Epub 2013 May 30.
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.
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.
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.
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.
心房颤动（AF）与左心室舒张功能障碍（LVDD）之间的相互作用复杂且尚未明确。尽管 AF 患者中 LVDD 的患病率较高，但 LVDD 的治疗方法仍然有限。先前的研究表明，导管消融恢复窦性心律对 LVDD 有积极影响，但 LVDD 恶化的患病率和预测因素尚不清楚。
前瞻性 AF 导管消融登记研究中纳入了 70 例连续患者（61±10 岁，66%为男性），包括阵发性（n=40）或持续性 AF（n=30）。在消融前和消融后 12 个月，通过经胸超声心动图进行检查。根据现行指南对 LVDD 进行分类。通过连续 7 天的 Holter ECG 验证消融的节律结果。
基线时有 27 例（38%）患者存在 LVDD，随访 12 个月时有 33 例（47%）患者存在 LVDD（p=.327）。13 例（19%）患者的 LVDD 得到改善，19 例（27%）患者的 LVDD 加重，而其余 38 例（54%）患者的 LVDD 无变化。在单变量和多变量回归分析中，总消融时间（每 10 分钟消融时间的 OR 1.611，95%CI 1.088-2.386，p=.017）与 LVDD 进展相关，而基线特征和随访期间的节律均不影响 LVDD 变化。超声心动图恶化与症状之间没有关联。
导管消融 AF 可使相当一部分患者的 LVDD 恶化，更积极的消融会导致 LVDD 加重。虽然没有明显的短期负面影响，但需要确定长期后果。
