Journal of Echocardiography

, Volume 9, Issue 2, pp 51–58 | Cite as

Effect of catheter ablation on the left ventricular mass index and other echocardiograph parameters in atrial fibrillation patients: comparison with antiarrhythmic drug treatment

  • Ki-Hun Kim
  • Jin Oh Na
  • Gi-Byoung Nam
  • Eun-Sun Jin
  • HyungOh Choi
  • Sung-Hwan Kim
  • Kee-Joon Choi
  • You-Ho Kim
Original Investigation

Abstract

Background

Catheter ablation (CA) is reported to improve left ventricular (LV) function in patients with atrial fibrillation (AF). This study compared the effects of CA and antiarrhythmic drug treatment (AT) on LV remodeling and other echocardiography parameters in AF.

Methods

We performed a non-randomized prospective study involving 72 drug-resistant AF patients who were treated with either CA (n = 42) or who declined CA and continued on AT (n = 30). Baseline and follow-up (mean 20.7 ± 7.5 months) echocardiography was performed in all patients. The maintenance of sinus rhythm was determined based on clinical interview, electrocardiography, and 24-h Holter and event recording.

Results

There were no significant differences between the two groups in regard to demographic features, blood pressure, and medication. CA was superior to AT with respect to sinus rhythm maintenance, LV ejection fraction, left atrium (LA) diameter, and LA volume index. In addition, CA resulted in decreases in the LV mass [from 190.5 ± 36.1 to 179.3 ± 32.4 g (p = 0.02)] and the LV mass index [from 104.2 ± 20.5 to 98.2 ± 18.3 g/m2 (p = 0.03)]. No parameter improved in AT patients. These improved echocardiographic parameters were observed in both groups with maintained sinus rhythm.

Conclusion

Reverse LV remodeling after CA may include a reduction in the LV mass index, which appears to be associated with sinus rhythm maintenance.

Keywords

Atrial fibrillation Catheter ablation Antiarrhythmia agents Echocardiography 

References

  1. 1.
    Noheria A, Kumar A, Wylie JV Jr, Josephson ME. Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med. 2008;168:581–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Kim YH. Rhythm control versus rate control of atrial fibrillation: pharmacologic and non-pharmacologic therapy. Korean Circ J. 2003;33:553–8.Google Scholar
  3. 3.
    Jaïs P, Weerasooriya R, Shah DC, Hocini M, Macle L, Choi KJ, et al. Ablation therapy for atrial fibrillation (AF): past, present and future. Cardiovasc Res. 2002;54:337–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Roy D, Talajic M, Dubuc M, Thibault B, Guerra P, Macle L, et al. Atrial fibrillation and congestive heart failure. Curr Opin Cardiol. 2009;24:29–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Hsu LF, Jaïs P, Sanders P, Garrigue S, Hocini M, Sacher F, et al. Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med. 2004;351:2373–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Morrow JP, Reiffel JA. Drug therapy for atrial fibrillation: what will its role be in the era of increasing use of catheter ablation? Pacing Clin Electrophysiol. 2009;32:108–18.PubMedCrossRefGoogle Scholar
  7. 7.
    Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008;358:2667–77.PubMedCrossRefGoogle Scholar
  8. 8.
    Novak PG. Effectiveness of catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation. Curr Opin Cardiol. 2009;24:9–17.PubMedCrossRefGoogle Scholar
  9. 9.
    Jaïs P, Cauchemez B, Macle L, Daoud E, Khairy P, Subbiah R, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498–505.PubMedCrossRefGoogle Scholar
  10. 10.
    Forleo GB, Mantica M, De Luca L, Leo R, Santini L, Panigada S, et al. Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. J Cardiovasc Electrophysiol. 2009;20:22–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Reant P, Lafitte S, Jaïs P, Serri K, Weerasooriya R, Hocini M, et al. Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation. 2005;112:2896–903.PubMedGoogle Scholar
  12. 12.
    Reant P, Lafitte S, Bougteb H, Sacher F, Mignot A, Douard H, et al. Effect of catheter ablation for isolated paroxysmal atrial fibrillation on longitudinal and circumferential left ventricular systolic function. Am J Cardiol. 2009;103:232–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257–354.PubMedCrossRefGoogle Scholar
  14. 14.
    Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55:613–8.PubMedGoogle Scholar
  15. 15.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Al-Omari MA, Finstuen J, Appleton CP, Barnes ME, Tsang TS. Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation. Am J Cardiol. 2008;101:1759–65.PubMedCrossRefGoogle Scholar
  18. 18.
    Watanabe T, Iwai-Takano M, Oikawa M, Yamaki T, Yaoita H, Maruyama Y. Optimal noninvasive assessment of diastolic heart failure in patients with atrial fibrillation: comparison of tissue Doppler echocardiography, left atrium size, and brain natriuretic peptide. J Am Soc Echocardiogr. 2008;21:689–96.PubMedCrossRefGoogle Scholar
  19. 19.
    Efremidis M, Sideris A, Xydonas S, Letsas KP, Alexanian IP, Manolatos D, et al. Ablation of atrial fibrillation in patients with heart failure: reversal of atrial and ventricular remodelling. Hellenic J Cardiol. 2008;49:19–25.PubMedGoogle Scholar
  20. 20.
    Gentlesk PJ, Sauer WH, Gerstenfeld EP, Lin D, Dixit S, Zado E, et al. Reversal of left ventricular dysfunction following ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:9–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52:2148–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Gardin JM, Lauer MS. Left ventricular hypertrophy: the next treatable, silent killer? JAMA. 2004;292:2396–8.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2010

Authors and Affiliations

  • Ki-Hun Kim
    • 1
  • Jin Oh Na
    • 1
  • Gi-Byoung Nam
    • 1
  • Eun-Sun Jin
    • 1
  • HyungOh Choi
    • 1
  • Sung-Hwan Kim
    • 1
  • Kee-Joon Choi
    • 1
  • You-Ho Kim
    • 1
  1. 1.Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

Personalised recommendations