Santos Simone Nascimento dos, Henz Benhur Davi, Zanatta André Rodrigues, Barreto José Roberto, Loureiro Kelly Bianca, Novakoski Clarissa, Santos Marcus Vinícius Nascimento dos, Giuseppin Fabio F, Oliveira Edna Maria, Leite Luiz Roberto
Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil.
Arq Bras Cardiol. 2014 Dec;103(6):485-92. doi: 10.5935/abc.20140152. Epub 2014 Oct 14.
Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process.
To evaluate the impact of AF ablation on estimated LV filling pressure.
A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation.
One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m(2) ± 10.6 mL/m(2) to 22.6 mL/m(2) ± 1.1 mL/m(2), p < 0.001) compared to the non-successful group (37.7 mL/m(2) ± 14.3 mL/m(2) to 37.5 mL/m(2) ± 14.5 mL/m(2), p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001).
Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.
左心室舒张功能障碍与新发房颤相关，通过E/e'比值评估左心室充盈压升高与房颤患者更差的预后有关。然而，恢复窦性心律是否能逆转这一过程尚不清楚。
评估房颤消融对估计的左心室充盈压的影响。
共有141例患者接受射频消融治疗药物难治性房颤。在消融前30天和消融后12个月进行经胸超声心动图检查。评估左心室功能参数、左心房容积指数（LAVind）以及二尖瓣脉冲和二尖瓣环组织多普勒（e'和E/e'）。18例患者为阵发性房颤，102例患者为持续性房颤，21例患者为长期持续性房颤。随访包括消融后3、6和12个月的心电图检查和24小时动态心电图监测。
117例患者（82.9%）在随访期间（平均18±5个月）无房颤。与未成功组（37.7 mL/m²±14.3 mL/m²至37.5 mL/m²±14.5 mL/m²，p=无显著性差异）相比，成功组的LAVind降低（30.2 mL/m²±10.6 mL/m²至22.6 mL/m²±1.1 mL/m²，p<0.001）。仅在成功消融后观察到通过E/e'比值降低评估的左心室充盈压改善（11.5±4.5对7.1±3.7，p<0.001），而复发性房颤患者未观察到改善（12.7±4.4对12±3.3，p=无显著性差异）。长期持续性房颤患者组的成功率较低（57%对87%，p=0.001）。
成功的房颤消融与左心房逆向重构和左心室充盈压改善相关。
