Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 4:41:101079.
doi: 10.1016/j.ijcha.2022.101079. eCollection 2022 Aug.

Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation

Affiliations

Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation

Toshiharu Koike et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The relationship between pre-ablation left ventricular diastolic dysfunction (LVDD) and prognosis in patients with left ventricular systolic dysfunction (LVSD) undergoing atrial fibrillation (AF) ablation remains unclear.

Methods: The prognosis of 173 patients with impaired left ventricular ejection fraction (<50%) who underwent AF ablation was examined. The primary outcome was a composite of all-cause mortality, heart failure (HF) hospitalization, and worsening HF symptoms requiring unplanned outpatient intensification of decongestive therapy.

Results: During the follow-up period (median, 3.5 years), the primary outcome after AF ablation occurred in 28 patients (16%). The receiver operating characteristic curve analysis showed that early septal diastolic mitral annular velocity (e') had a larger area under the curve (0.70) than other LVDD parameters, and optimal cut-off values of LVDD, represented by e', septal E (early diastolic left ventricular filling velocity)/e', and peak tricuspid valve regurgitation velocity (TRV), were 5.0 cm/s, 13.2, and 2.5 m/s, respectively. Multivariate analysis revealed that e' ≤5.0 cm/s (standard hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.73-8.69; p = 0.001), septal E/e' ≥13.2 (HR, 3.62; 95% CI, 1.60-8.21; p = 0.002), and peak TRV ≥ 2.5 m/s (HR, 2.42; 95% CI, 1.13-5.16; p = 0.02) independently predicted the outcome. Patients with New York Heart Association functional status ≥ III had a 3.3-4.5-fold higher risk of the outcome.

Conclusions: LVDD or severe HF symptoms predict poor outcomes in patients with LVSD undergoing AF ablation. Therefore, patients with LVDD or severe HF symptoms should receive more intensive treatment even after AF ablation.

Keywords: AAD, antiarrhythmic drug; AF, atrial fibrillation; AFMR, atrial functional MR; ATA, atrial tachyarrhythmia; AUC, area under the curve; Atrial fibrillation; CRT, cardiac resynchronization therapy; Catheter ablation; DT, deceleration time; Diastolic dysfunction; E, early diastolic left ventricular filling velocity; HF, heart failure; HFH, HF hospitalization; HFrEF, HF with reduced ejection fraction; Heart failure; IQR, interquartile ranges; LA, left atrial; LAVI, LA volume index; LV, left ventricular; LVAD, LV assist device; LVDD, left ventricular diastolic dysfunction; LVEF, LV ejection fraction; LVSD, left ventricular systolic dysfunction; MR, mitral regurgitation; NYHA, New York Heart Association; PAF, paroxysmal AF; PMI, pacemaker implantation; ROC, receiver operating characteristic; SD, standard deviations; SHD, structural heart disease; TRV, tricuspid valve regurgitation velocity; VFMR, ventricular functional MR; e′, early septal diastolic mitral annular velocity; rEF, reduced ejection fraction.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Flowchart of the selection process. AF, atrial fibrillation; CRT, cardiac resynchronization therapy; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; PMI, pacemaker implantation.
Fig. 2
Fig. 2
Clinical outcome-free survival rates in each patient group categorized by septal e′ peak velocity. Kaplan–Meier curves showing the difference in the cumulative rate of (a) the composite of (b) all-cause mortality, (c) heart failure hospitalization, and (d) worsening heart failure symptoms requiring unplanned outpatient intensification of decongestive therapy between the septal e′ peak velocity ≤ 5.0 cm/s group and the septal e′ peak velocity > 5.0 cm/s group. e′, septal early diastolic mitral annular velocity.
Supplementary figure 1
Supplementary figure 1
Supplementary figure 2
Supplementary figure 2

Similar articles

Cited by

References

    1. Cha Y.M., Wokhlu A., Asirvatham S.J., et al. Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function. Circ Arrhythm Electrophysiol. 2011;4:724–732. - PubMed
    1. Hsu L.F., Jaïs P., Sanders P., et al. Catheter ablation for atrial fibrillation in congestive heart failure. N. Engl. J. Med. 2004;351:2373–2383. - PubMed
    1. Tsang T.S., Gersh B.J., Appleton C.P., et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J. Am. Coll. Cardiol. 2002;40:1636–1644. - PubMed
    1. Vasan R.S., Larson M.G., Levy D., et al. Doppler transmitral flow indexes and risk of atrial fibrillation (the Framingham Heart Study) Am. J. Cardiol. 2003;91:1079–1083. - PubMed
    1. Wazni O.M., Marrouche N.F., Martin D.O., et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293:2634–2640. - PubMed