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Europace Advance Access published online on October 31, 2009
Europace, doi:10.1093/europace/eup309
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

CLINICAL RESEARCH

Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation

Tom De Potter, Antonio Berruezo*, Lluis Mont, Maria Matiello, David Tamborero, Claudio Santibañez, Begoña Benito, Nibaldo Zamorano and Josep Brugada

Cardiology Department, Arrhythmia Section, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain

Aims: The objective of the study was to analyse the influence of left ventricular (LV) ejection fraction (EF) on the outcomes of atrial fibrillation (AF) ablation after a first procedure. Pre-procedural predictors of recurrences after AF ablation can be useful for patient information and selection of candidates. The independent influence of LV systolic dysfunction on recurrence rate has not been studied.

Methods and results: A case–control study (1:1) was conducted with a total of 72 patients: 36 cases (depressed LVEF) and 36 controls (normal LVEF). Patients were matched by left atrial diameter (LAD), the presence of arterial hypertension, and other variables that might influence the results (age, gender and paroxysmal vs. persistent AF). There were no statistical differences in the variables used to perform the matching. Patients with depressed LVEF had higher LV end diastolic diameter (55.6 ± 6.2 vs. 52.4 ± 5.5, P = 0.03), higher LV end systolic diameter (40.3 ± 6.9 vs. 32.6 ± 4.3, P < 0.001), lower LVEF (41.4 ± 8.0 vs. 63.1 ± 5.5, P < 0.001) and were more likely to have structural heart disease. After a mean follow-up of 16 ± 13 months, survival analysis for AF recurrences showed no differences between patients with depressed vs. normal LVEF (50.0 vs. 55.6%, log rank = 0.82). Cox regression analysis revealed LAD to be the only variable correlated to recurrence [OR 1.11 (1.01–1.22), P = 0.03]. Analysis at 6 months showed a significant increase in LVEF (43.23 ± 7.61 to 51.12 ± 13.53%, P = 0.01) for the case group.

Conclusion: LV systolic dysfunction by itself is not a predictor of outcome after AF ablation. LAD independently correlates with outcome in patients with low or normal LVEF.

Key Words: Atrial fibrillation, Radiofrequency ablation, Heart failure

* Corresponding author. Tel: +34 932275551, Fax: +34 934513045, Email: berruezo{at}clinic.ub.es

Manuscript submitted 4 May 2009. Accepted after revision 14 September 2009.


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