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

Abstract

BackgroundLeft 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.ObjectiveTo evaluate the impact of AF ablation on estimated LV filling pressure.MethodsA 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.ResultsOne 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/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001) compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, 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).ConclusionSuccessful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?

“…First, a previous study demonstrated that successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure. [ 36 ] Other studies have also revealed that the restrictive filling pattern (RFP) is closely related atrial fibrillation, although the mechanism has not been well explained. [ 37 , 38 ] RFP is characterized by advanced diastolic dysfunction, which can overload LA pressure and initiate LA remodeling; this effect can lead to structural and electrophysiological heterogeneity, which can create a substrate for AF occurrence.…”

The association between atrial fibrillation and cognitive function in patients with heart failure

“…46 In the current study, we could not rule out the possibility of subclinical stroke as potential mechanisms, because a history of stroke was only ascertained by medical record review rather than by detailed imaging. Another possible mechanism is that the loss of atrioventricular synchrony and impairment of left ventricular filling during AF lead to a reduction of cardiac output 47 and ultimately result in cerebral hypoperfusion. 48,49 This hypothesis is supported by a recent study which suggested that AF exacerbated cognitive dysfunction in HF patients possibly through greater reduction in cerebral blood flow.…”

Long-Term Clinical Outcomes Following Cryoballoon Ablation in Patients with Paroxysmal Atrial Fibrillation: Single-Center Experience

“…Consequently, this perpetuates the development of a new substrate for AF. [13] In the catheter ablation guidelines published by the European Heart Rhythm Association (EHRA) in 2017, it is mentioned that studies conducted after AF ablation procedures have examined the main factors in terms of recurrence. These factors include non-paroxysmal AF types, increased left atrial diameter, age, hypertension, and the presence of left atrial fibrosis in MR. [14] In a meta-analysis involving 7217 patients who underwent ablation procedures, serious left atrial enlargement (>50 mm) was identified as a significant predictor when examining recurrence predictors.…”