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Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

BACKGROUND: 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 proce...

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Autores principales: dos Santos, Simone Nascimento, Henz, Benhur Davi, Zanatta, André Rodrigues, Barreto, José Roberto, Loureiro, Kelly Bianca, Novakoski, Clarissa, dos Santos, Marcus Vinícius Nascimento, Giuseppin, Fabio F., Oliveira, Edna Maria, Leite, Luiz Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cardiologia 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290739/
https://www.ncbi.nlm.nih.gov/pubmed/25590928
http://dx.doi.org/10.5935/abc.20140152
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author dos Santos, Simone Nascimento
Henz, Benhur Davi
Zanatta, André Rodrigues
Barreto, José Roberto
Loureiro, Kelly Bianca
Novakoski, Clarissa
dos Santos, Marcus Vinícius Nascimento
Giuseppin, Fabio F.
Oliveira, Edna Maria
Leite, Luiz Roberto
author_facet dos Santos, Simone Nascimento
Henz, Benhur Davi
Zanatta, André Rodrigues
Barreto, José Roberto
Loureiro, Kelly Bianca
Novakoski, Clarissa
dos Santos, Marcus Vinícius Nascimento
Giuseppin, Fabio F.
Oliveira, Edna Maria
Leite, Luiz Roberto
author_sort dos Santos, Simone Nascimento
collection PubMed
description BACKGROUND: 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. OBJECTIVE: To evaluate the impact of AF ablation on estimated LV filling pressure. METHODS: 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. RESULTS: 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). CONCLUSION: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.
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spelling pubmed-42907392015-02-06 Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling dos Santos, Simone Nascimento Henz, Benhur Davi Zanatta, André Rodrigues Barreto, José Roberto Loureiro, Kelly Bianca Novakoski, Clarissa dos Santos, Marcus Vinícius Nascimento Giuseppin, Fabio F. Oliveira, Edna Maria Leite, Luiz Roberto Arq Bras Cardiol Original Articles BACKGROUND: 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. OBJECTIVE: To evaluate the impact of AF ablation on estimated LV filling pressure. METHODS: 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. RESULTS: 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). CONCLUSION: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure. Sociedade Brasileira de Cardiologia 2014-12 /pmc/articles/PMC4290739/ /pubmed/25590928 http://dx.doi.org/10.5935/abc.20140152 Text en http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
dos Santos, Simone Nascimento
Henz, Benhur Davi
Zanatta, André Rodrigues
Barreto, José Roberto
Loureiro, Kelly Bianca
Novakoski, Clarissa
dos Santos, Marcus Vinícius Nascimento
Giuseppin, Fabio F.
Oliveira, Edna Maria
Leite, Luiz Roberto
Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title_full Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title_fullStr Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title_full_unstemmed Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title_short Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling
title_sort impact of atrial fibrillation ablation on left ventricular filling pressure and left atrial remodeling
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290739/
https://www.ncbi.nlm.nih.gov/pubmed/25590928
http://dx.doi.org/10.5935/abc.20140152
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