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 Andrew Friedman, Thomas M. Munger, Jae Kuen Oh, Kristi H. Monahan, Janis M. Haroldson, David O. Hodge, Regina M. Herges, Stephen C. Hammill, Douglas L Packer

Research output: Contribution to journalArticle

74 Citations (Scopus)

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 2011

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Ventricular Function
Left Ventricular Dysfunction
Atrial Fibrillation
Anti-Arrhythmia Agents
Left Ventricular Function
Recurrence
Quality Improvement
Stroke Volume
Cardiac Arrhythmias
Quality of Life

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction : A comparison to systolic dysfunction and normal ventricular function. / Cha, Yong-Mei; Wokhlu, Anita; Asirvatham, Samuel J; Shen, Win Kuang; Friedman, Paul Andrew; Munger, Thomas M.; Oh, Jae Kuen; Monahan, Kristi H.; Haroldson, Janis M.; Hodge, David O.; Herges, Regina M.; Hammill, Stephen C.; Packer, Douglas L.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 4, No. 5, 10.2011, p. 724-732.

Research output: Contribution to journalArticle

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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.",
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T1 - Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction

T2 - A comparison to systolic dysfunction and normal ventricular function

AU - Cha, Yong-Mei

AU - Wokhlu, Anita

AU - Asirvatham, Samuel J

AU - Shen, Win Kuang

AU - Friedman, Paul Andrew

AU - Munger, Thomas M.

AU - Oh, Jae Kuen

AU - Monahan, Kristi H.

AU - Haroldson, Janis M.

AU - Hodge, David O.

AU - Herges, Regina M.

AU - Hammill, Stephen C.

AU - Packer, Douglas L

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AB - 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.

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KW - Cardiomyopathies

KW - Catheter ablation

KW - Heart failure diastolic

KW - Heart failure systolic

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