Document Detail

Success of Ablation for Atrial Fibrillation in Isolated Left Ventricular Diastolic Dysfunction: A Comparison to Systolic Dysfunction and Normal Ventricular Function.
MedLine Citation:
PMID:  21747059     Owner:  NLM     Status:  Publisher    
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 functions underwent ablation for anti-arrhythmic 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 endpoint was AAD-free AF elimination at 1 year after ablation. This was achieved in 62% of patients with systolic dysfunction, 75% of those with diastolic dysfunction, and 84% of controls (P=.007). AF control on or off AADs was achieved in 76% of those with systolic dysfunction, 85% of those with diastolic dysfunction, and 89% of controls (P=.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% confidence interval, 1.1 to 3.1; P=.02) in systolic dysfunction and 1.7 (1.0 to 2.7; P=.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 left ventricular functional benefit.
Yong-Mei Cha; Anita Wokhlu; Samuel J Asirvatham; Win-Kuang K Shen; Paul A Friedman; Thomas M Munger; Jae K Oh; Kristi H Monahan; Janis M Haroldson; David O Hodge; Regina M Herges; Stephen C Hammill; Douglas L Packer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-11
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Mayo Clinic, Rochester, MN.
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