Usefulness of left ventricular diastolic function to predict recurrence of atrial fibrillation in patients with preserved left ventricular systolic function.

It is unknown whether recurrence of atrial fibrillation (AF) is related to severity of left ventricular diastolic dysfunction (LVDD) before ablation in patients with preserved left ventricular ejection fraction (LVEF). We tested the hypothesis that the presence and/or severity of LVDD before catheter ablation are related to AF recurrence during the 12-month follow-up period in patients with normal LVEF. We also aimed to determine what echocardiographic and Doppler indexes of LVDD before ablation are associated with recurrence of AF after ablation. We identified 198 patients with normal LVEF who underwent catheter ablation for AF with evidence of normal sinus rhythm within 1 year before ablation. The recurrence rate during 12-month follow-up period was assessed. Of the 198 patients, 76 patients (38%) had symptomatic recurrence and 122 patients (62%) had no recurrence. None of the independent variables, including mitral valve Doppler E and A peak velocities, E/A ratio, tissue Doppler e' and a' peak velocities, left atrial volume index, isovolumic relaxation time, and deceleration time, predicted recurrence. Patients with average E/e' ratio >13, however, had increased recurrence (67% vs 35%, odds ratio 3.70, 95% confidence interval 1.21 to 11.3, p <0.05). In conclusion, there was no difference in the severity of LVDD using conventional echocardiographic indexes of LVDD in patients with or without recurrence of AF ablation. However, patients with average E/e' ratio >13 did have an increased recurrence rate of AF at 12 months after procedure. Therefore, E/e' ratio, indicative of increased left atrial pressure, may serve as a marker for AF recurrence after ablation.