Selection for atrial fibrillation ablation: Importance of diastolic function grading

J Cardiol. 2015 Jun;65(6):479-86. doi: 10.1016/j.jjcc.2014.07.018. Epub 2014 Aug 26.


Background: Pulmonary vein isolation (PVI) has become an accepted therapy for patients with atrial fibrillation (AF) and the indications have widened to include non-paroxysmal AF-patients. Maintenance of sinus rhythm after PVI can be adversely affected by clinical or echocardiographic parameters, which should be clearly identified.

Methods and results: After baseline clinical and echocardiographic evaluations, PVI was performed in patients with paroxysmal or non-paroxysmal AF. The follow-up strategy after PVI included: (1) clinical follow up, 12-lead electrocardiography (ECG) and 24-h ECG every 3 months, (2) trans-telephonic ECGs twice daily and when symptomatic (over 4 weeks) every 3 months, or (3) continuous monitoring via implanted devices. A recurrence was an atrial arrhythmia lasting >30s. All 340 PVI procedures of 229 patients were analyzed. On average, 1.5 PVI procedures per patient (range, 1-6 PVI) were performed. The mean age was 58±11 years (73% male) with 109 paroxysmal and 120 non-paroxysmal AF cases. Clinical follow-up with 12-lead ECGs, 24-h ECGs, trans-telephonic ECGs, and implanted devices was complete in 100%, 63%, 51%, and 16% of cases, respectively. The overall one-year recurrence rate of 59% (range, 24-82%) was dependent on grades of diastolic function (normal - dysfunction grade III) in a multivariable analysis model. Patients with normal diastolic function had the lowest recurrence rates of 24% and 49% after 1 and 3 years of follow-up, respectively (p<0.0001).

Conclusion: Diastolic function could serve as a simple summary predictor for AF recurrence, and would facilitate clinical decision-making in AF treatment.

Keywords: Atrial fibrillation; Diastolic function; Pulmonary vein isolation.

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / physiopathology*
  • Atrial Fibrillation / surgery*
  • Catheter Ablation*
  • Diastole / physiology*
  • Electrocardiography / methods
  • Electrophysiologic Techniques, Cardiac / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Veins*
  • Recurrence
  • Retrospective Studies
  • Tachycardia, Paroxysmal / physiopathology
  • Tachycardia, Paroxysmal / surgery
  • Time Factors
  • Treatment Outcome
  • Ultrasonography