Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation
- PMID: 35812132
- PMCID: PMC9260613
- DOI: 10.1016/j.ijcha.2022.101079
Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation
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.
© 2022 The Author(s).
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.
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