Improvement of left ventricular function after successful radiofrequency catheter ablation in persistent atrial fibrillation with preserved left ventricular ejection fraction: a comprehensive echocardiographic assessment using two-dimensional speckle tracking analysis

BackgroundA limited number of studies have investigated the effects of radiofrequency catheter ablation (RFCA) on left ventricular (LV) function and the left atrial (LA) size in patients with atrial fibrillation (AF). The purpose of this study was to conduct a comprehensive assessment of LV function in patients with AF with preserved left ventricular ejection fraction (LVEF) before and after RFCA.MethodA total of 30 consecutive patients with no recurrences after RFCA for persistent AF (age, 57.78.4years) were enrolled. Transthoracic echocardiography was performed at the baseline and 6months after the final RFCA using speckle tracking derived LV strain analysis.ResultsAfter RFCA, we measured decreases in the LA volume index (33.7 +/- 10.4ml/m(2) vs. 24.6 +/- 8.6ml/m(2), p<0.0001), while we observed improvements in systolic indices such as LVEF (56.8 +/- 9.8% vs. 65.1 +/- 9.1%, p<0.0001), global longitudinal strain (-16.8 +/- 4.4% vs. -18.8 +/- 3.4%, p=0.0055) and twist (8.12 +/- 3.66 degrees vs. 12.33 +/- 6.75 degrees, p=0.0050), and also in diastolic indices such as strain rate during early diastole (SRE) (0.73 +/- 0.10s(-1) vs. 1.32 +/- 0.29s(-1), p<0.0001) and early transmitral inflow velocity (E)/SRE (1.11 +/- 0.36m vs. 0.61 +/- 0.19m, p<0.0001). Logistic regression analysis showed that E/SRE was a contributing factor for improvement in LVEF (odds ratio 126.9; p=0.021).Conclusionn persistent AF with preserved LVEF, further improvement in LVEF and reverse remodeling of the LA are achieved after RFCA. LV filling pressure may play significant roles in the mechanisms.