Impact of atrial fibrillation-induced tachycardiomyopathy in patients undergoing pulmonary vein isolation

Abstract

Introduction: Atrial fibrillation (AF) is a recognized treatable cause of tachycardiomyopathy (TMP), with class IIb indication for catheter ablation (CA). The aim of this study is to analyze the prevalence, clinical characteristics and effect of CA in patients with TMP and to evaluate TMP as a prognostic factor for AF recurrence in these patients (TMP group), compared to controls with normal left ventricular ejection fraction (LVEF) and patients with heart failure due to structural cardiomyopathy (HF group).

Methods and results: The study groups included 659 consecutive patients undergoing CA between 2003 and 2011: TMP group (n = 61), HF group (n = 36) and control group (n = 562). Compared to controls, patients with TMP were younger, had a shorter AF course and more often had persistent AF. Regarding echocardiographic parameters, the TMP group had lower LVEF (40% vs. 62%, P < 0.05), larger left atrial diameter (LAD: 46 vs. 41 mm, P < 0.05) and LV end-diastolic diameter (LVEDD: 55 vs. 51 mm, P < 0.05) compared to controls, with significant improvement at six-month follow-up, including those patients with AF recurrence. The probability of being arrhythmia-free did not differ between the TMP group and the other groups after a first or last procedure. The only independent predictor of AF recurrence was LAD.

Conclusions: Patients with tachycardiomyopathy secondary to AF benefit from CA, with a significant improvement in LVEF, LVEDD and LAD. The outcome after CA of this group did not differ from patients with no structural cardiomyopathy.

Keywords: Atrial fibrillation; Catheter Ablation; Heart Failure; Tachycardiomyopathy.