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