Ahluwalia Nikhil, Bruce David, Ashdown Ashley, Focacci Fabrizio, Abbass Hakam, Honarbakhsh Shohreh, Chow Anthony, Dhinoja Mehul, Hunter Ross J, Petersen Steffen, Lloyd Guy, Schilling Richard J
St Bartholomew's Hospital, Barts Heart Centre, London, UK.
Queen Mary University of London, London, UK.
J Cardiovasc Electrophysiol. 2025 May;36(5):945-951. doi: 10.1111/jce.16606. Epub 2025 Feb 21.
Exercise Oscillatory Ventilation (EOV) and a steep ventilatory efficiency (VE/VCO2) slope are features of ventilatory inefficiency on cardiopulmonary exercise testing (CPET), both associated with poor prognosis in patients with heart failure (HF). The prevalence in patients with co-existent atrial fibrillation (AF) and the impact of catheter ablation (CA) is unknown.
To characterize ventilatory inefficiency in patients with persistent AF and Left Ventricular Systolic Dysfunction (LVSD) and assess the impact of CA.
Patients with persistent AF and Left Ventricular Ejection Fraction (LVEF) < 50% undergoing first-time CA were prospectively enrolled. Echocardiography and CPET were performed at baseline and 6 months post-CA. EOV was defined using the Kremser-Corrà criteria, and VE/VCO2 slope gradient > 30 was considered abnormal.
A total of 53 participants were enrolled (mean LVEF of 34 ± 9%). A total of 10 (19.2%) exhibited EOV at baseline. These patients had larger indexed left atrial (41.6 ± 13.1 mL/m vs. 33.3 ± 9.3 mL/m, p = 0.03) and ventricular volumes [65.7 mL/m (57.1, 89.0) vs. 46.7 mL/m (39.8, 61.4), p = 0.03]. The partial pressure of end-tidal carbon dioxide (PCO) at peak exercise increased (33.7 ± 6.1 mmHg to 41.2 ± 5.8 mmHg, p < 0.001) and correlated with improvement in HF symptoms (p = -0.003) and objective HF markers. A total of 25 (48.1%) had an abnormal VE/VCO2 gradient. The EOV pattern resolved in eight (80%) participants due to a reduction in EOV burden (71.1 ± 11.9% vs. 48.8 ± 14.8%, p = 0.006) and the component amplitude of minute ventilation cycles (2.6 L/min (2.5,3.2) vs 2.2 L/min (1.8,2.6), p = 0.028). Fewer patients had an abnormal VE/VCO2 gradient after CA [25 (48.1%) vs. 16 (34.0%), p = 0.004].
Ventilatory inefficiency is common in patients with AF and LVSD. CA improves both EOV and VE/VCO2 in AF-induced cardiomyopathy. Improvement in PCO is also seen and correlates with HF symptom burden.
运动振荡通气（EOV）和陡峭的通气效率（VE/VCO2）斜率是心肺运动试验（CPET）中通气效率低下的特征，二者均与心力衰竭（HF）患者的不良预后相关。合并心房颤动（AF）患者的患病率以及导管消融（CA）的影响尚不清楚。
描述持续性AF和左心室收缩功能障碍（LVSD）患者的通气效率低下情况，并评估CA的影响。
前瞻性纳入首次接受CA治疗的持续性AF和左心室射血分数（LVEF）<50%的患者。在基线和CA后6个月进行超声心动图和CPET检查。EOV采用克雷姆泽-科拉标准定义，VE/VCO2斜率梯度>30被认为异常。
共纳入53名参与者（平均LVEF为34±9%）。共有10名（19.2%）在基线时表现出EOV。这些患者的左心房指数较大（41.6±13.1 mL/m对33.3±9.3 mL/m，p=0.03）和心室容积[65.7 mL/m（57.1，89.0）对46.7 mL/m（39.8，61.4），p=0.03]。运动峰值时的呼气末二氧化碳分压（PCO）升高（33.7±6.1 mmHg至41.2±5.8 mmHg，p<0.001），并与HF症状改善（p=-0.003）和客观HF标志物相关。共有25名（48.1%）患者的VE/VCO2梯度异常。由于EOV负担减轻（71.1±11.9%对48.8±14.8%，p=0.006）和分钟通气周期的分量幅度减小（2.6 L/min（2.5，3.2）对2.2 L/min（1.8，2.6），p=0.028），8名（80%）参与者的EOV模式得到改善。CA后VE/VCO2梯度异常的患者减少[25名（48.1%）对16名（34.0%），p=0.004]。
通气效率低下在AF和LVSD患者中很常见。CA可改善AF诱发的心肌病中的EOV和VE/VCO2。PCO也有所改善，且与HF症状负担相关。
