Skip to main content
Log in

Changes in left ventricular filling parameters following catheter ablation of atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Atrial fibrillation (AF) is common in the setting of abnormal ventricular relaxation.

We evaluated the association between ventricular relaxation grade and atrial fibrosis and examined the change in left ventricular filling parameters following catheter ablation.

Methods and results

AF patients undergoing catheter ablation who had cardiac late gadolinium enhancement MRI (LGE-MRI) and echocardiographic examinations were included in the study. Left atrial (LA) tissue fibrosis and volume were quantified using LGE-MRI. Echocardiograms were performed at baseline and 3 months following catheter ablation to assess left ventricular (LV) filling. Two hundred and ninety three patients (60.8 % male) met the inclusion criteria. In patients in sinus rhythm at baseline (n = 115), ventricular relaxation pattern was identified as normal in 54 patients (47.0 %), impaired in 35 (30.4 %), pseudo-normal in 18 (15.7 %), and restrictive in 8 (7.0 %). Restrictive LV filling was associated with higher LA volume index (61.2 ± 30.5 vs 46.0 ± 18.5 ml/m2; p < 0.01) and LA fibrosis (21.8 ± 10.9 % vs 15.5 ± 9.4 %; p = 0.036) compared to non-restrictive filling. In patients in sinus rhythm on both pre- and post-ablation echocardiograms (n = 104), A waves decreased from 0.70 ± 0.23 at baseline to 0.60 ± 0.20 (p < 0.01) and E/E’ decreased from 9.6 ± 4.0 at baseline to 8.6 ± 3.5 (p = 0.03). Thirty-two patients (27.2 %) had an improvement, and 24 patients (23.1 %) had a worsening in diastolic grade. Clinical heart failure and diabetes were associated with worse diastolic grade post-ablation.

Conclusions

Restrictive LV filling is associated with higher LA fibrosis. A change in echocardiographic LV filling pattern was noted in over 50 % of patients post-ablation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., et al. (2011). ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Journal of the American College of Cardiology, 57(11), e101–98.

    Article  PubMed  Google Scholar 

  2. Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA, the Journal of the American Medical Association, 285(18), 2370–5.

    Article  CAS  PubMed  Google Scholar 

  3. Owan, T. E., Hodge, D. O., Herges, R. M., Jacobsen, S. J., Roger, V. L., & Redfield, M. M. (2006). Trends in prevalence and outcome of heart failure with preserved ejection fraction. The New England Journal of Medicine, 355(3), 251–9.

    Article  CAS  PubMed  Google Scholar 

  4. Tsang, T. S., Gersh, B. J., Appleton, C. P., Tajik, A. J., Barnes, M. E., Bailey, K. R., et al. (2002). Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. Journal of the American College of Cardiology, 40(9), 1636–44.

    Article  PubMed  Google Scholar 

  5. Tokushima, T., Reid, C. L., & Gardin, J. M. (2001). Left ventricular diastolic function in the elderly. The American Journal of Geriatric Cardiology, 10(1), 20–9.

    Article  CAS  PubMed  Google Scholar 

  6. Lee, D. S., Gona, P., Vasan, R. S., Larson, M. G., Benjamin, E. J., Wang, T. J., et al. (2009). Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation, 119(24), 3070–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rosenberg, M. A., Gottdiener, J. S., Heckbert, S. R., & Mukamal, K. J. (2012). Echocardiographic diastolic parameters and risk of atrial fibrillation: the Cardiovascular Health Study. European Heart Journal, 33(7), 904–12.

    Article  PubMed  Google Scholar 

  8. Allessie, M., Ausma, J., & Schotten, U. (2002). Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovascular Research, 54(2), 230–46.

    Article  CAS  PubMed  Google Scholar 

  9. Bosch, R. F., Zeng, X., Grammer, J. B., Popovic, K., Mewis, C., & Kühlkamp, V. (1999). Ionic mechanisms of electrical remodeling in human atrial fibrillation. Cardiovascular Research, 44(1), 121–31.

    Article  CAS  PubMed  Google Scholar 

  10. Casaclang-Verzosa, G., Gersh, B. J., & Tsang, T. S. (2008). Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. Journal of the American College of Cardiology, 51(1), 1–11.

    Article  PubMed  Google Scholar 

  11. Pappone, C., Rosanio, S., Oreto, G., Tocchi, M., Gugliotta, F., Vicedomini, G., et al. (2000). Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation, 102(21), 2619–28.

    Article  CAS  PubMed  Google Scholar 

  12. Marrouche, N. F., Dresing, T., Cole, C., Bash, D., Saad, E., Balaban, K., et al. (2002). Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies. Journal of the American College of Cardiology, 40(3), 464–74.

    Article  PubMed  Google Scholar 

  13. Oakes, R. S., Badger, T. J., Kholmovski, E. G., Akoum, N., Burgon, N. S., Fish, E. N., et al. (2009). Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation, 119(13), 1758–67.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Akoum, N., Daccarett, M., McGann, C., Segerson, N., Vergara, G., Kuppahally, S., et al. (2011). Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. Journal of Cardiovascular Electrophysiology, 22(1), 16–22.

    Article  PubMed  Google Scholar 

  15. McGann C, Akoum N, Patel A, Kholmovski E, Revelo P, Damal K, et al. Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI. Circulation Arrhythmia and electrophysiology. 2013.

  16. Khan, M. N., Jais, P., Cummings, J., Di Biase, L., Sanders, P., Martin, D. O., et al. (2008). Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. The New England Journal of Medicine, 359(17), 1778–85.

    Article  CAS  PubMed  Google Scholar 

  17. Hsu, L. F., Jais, P., Sanders, P., Garrigue, S., Hocini, M., Sacher, F., et al. (2004). Catheter ablation for atrial fibrillation in congestive heart failure. The New England Journal of Medicine, 351(23), 2373–83.

    Article  CAS  PubMed  Google Scholar 

  18. Cha, Y. M., Wokhlu, A., Asirvatham, S. J., Shen, W. K., Friedman, P. A., Munger, T. M., et al. (2011). Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function. Circulation. Arrhythmia and Electrophysiology, 4(5), 724–32.

    Article  PubMed  Google Scholar 

  19. Nagueh, S. F., Appleton, C. P., Gillebert, T. C., Marino, P. N., Oh, J. K., Smiseth, O. A., et al. (2009). Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Journal of the American Society of Echocardiography, 22(2), 107–33.

    Article  PubMed  Google Scholar 

  20. Maisel, W. H., & Stevenson, L. W. (2003). Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. The American Journal of Cardiology, 91(6A), 2D–8D.

    Article  PubMed  Google Scholar 

  21. Benjamin, E. J., Levy, D., Vaziri, S. M., D’Agostino, R. B., Belanger, A. J., & Wolf, P. A. (1994). Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA : The Journal of the American Medical Association, 271(11), 840–4.

    Article  CAS  PubMed  Google Scholar 

  22. Zakeri, R., Chamberlain, A. M., Roger, V. L., & Redfield, M. M. (2013). Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study. Circulation, 128(10), 1085–93.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hogg, K., Swedberg, K., & McMurray, J. (2004). Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. Journal of the American College of Cardiology, 43(3), 317–27.

    Article  PubMed  Google Scholar 

  24. McMurray, J. J., Carson, P. E., Komajda, M., McKelvie, R., Zile, M. R., Ptaszynska, A., et al. (2008). Heart failure with preserved ejection fraction: clinical characteristics of 4133 patients enrolled in the I-PRESERVE trial. European Journal of Heart Failure, 10(2), 149–56.

    Article  PubMed  Google Scholar 

  25. Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm : the Official Journal of the Heart Rhythm Society, 9(4), 632–96 e21.

    Article  Google Scholar 

  26. Medi, C., Kalman, J. M., Spence, S. J., Teh, A. W., Lee, G., Bader, I., et al. (2011). Atrial electrical and structural changes associated with longstanding hypertension in humans: implications for the substrate for atrial fibrillation. Journal of Cardiovascular Electrophysiology, 22(12), 1317–24.

    Article  PubMed  Google Scholar 

  27. De Jong, A. M., Van Gelder, I. C., Vreeswijk-Baudoin, I., Cannon, M. V., Van Gilst, W. H., & Maass, A. H. (2013). Atrial remodeling is directly related to end-diastolic left ventricular pressure in a mouse model of ventricular pressure overload. PloS One, 8(9), e72651.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Thomas, L., Thomas, S. P., Hoy, M., Boyd, A., Schiller, N. B., & Ross, D. L. (2004). Comparison of left atrial volume and function after linear ablation and after cardioversion for chronic atrial fibrillation. The American Journal of Cardiology, 93(2), 165–70.

    Article  PubMed  Google Scholar 

  29. Thomas, L., Boyd, A., Thomas, S. P., Schiller, N. B., & Ross, D. L. (2003). Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation. European Heart Journal, 24(21), 1942–51.

    Article  PubMed  Google Scholar 

Download references

Author contributions

NA contributed to the design, data analysis, and writing of the manuscript.

JK contributed to data collection and writing of the manuscript.

BW, CM, and NM provided critical reviews and edits of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nazem Akoum.

Ethics declarations

Patients were selected from the University of Utah Atrial Fibrillation Database and were included in this observational study. The University of Utah Institutional Review Board approved the database protocol.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krezowski, J.T., Wilson, B.D., McGann, C.J. et al. Changes in left ventricular filling parameters following catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 47, 83–89 (2016). https://doi.org/10.1007/s10840-016-0131-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0131-8

Keywords

Navigation