Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: A comparison to systolic dysfunction and normal ventricular function

Yong Mei Cha, Anita Wokhlu, Samuel J. Asirvatham, Win Kuang Shen, Paul A. Friedman, Thomas M. Munger, Jae K. Oh, Kristi H. Monahan, Janis M. Haroldson, David O. Hodge, Regina M. Herges, Stephen C. Hammill, Douglas L. Packer

Research output: Contribution to journalReview article

76 Scopus citations

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) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; 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 (P=0.007). 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 (P=0.08). In the systolic dysfunction group, 49% experienced an increase in LVEF by ≤5% 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; P=0.02) in systolic dysfunction and 1.7 (1.0 to 2.7; P=0.04) 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.

Original languageEnglish (US)
Pages (from-to)724-732
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number5
DOIs
StatePublished - Oct 1 2011

Keywords

  • Atrial fibrillation
  • Cardiomyopathies
  • Catheter ablation
  • Heart failure diastolic
  • Heart failure systolic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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