학국에서 심방세동의 임상양상에 관한 연구

이선미,조정휘,홍순조,최윤식,안신기,김성순,김영훈,김윤년,조정관,차태준,김유호,최기준,김준수,이상민,신동구 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.5

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery

손관협,신대희,변경민,한혜진,조수진,송영빈,김준형,온영근,김준수 대한심장학회 2009 Korean Circulation Journal Vol.39 No.3

Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates. Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.

The Difference of Left Atrial Volume Index : Can It Predict the Occurrence of Atrial Fibrillation after Radiofrequency Ablation of Atrial Flutter?

Kim, Ung,Kim, Young Jo,Kang, Sang Wook,Song, In Wook,Jo, Jung Hwan,Lee, Sang Hee,Hong, Geu Ru,Park, Jong Seon,Shin, Dong Gu 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

Background : The occurrence of atrial fibrillation after ablation of atrial flutter is clinically important. We investigated variables predicting this evolution in ablated patients without a previous atrial fibrillation history. Materials and Methods : Thirty-six patients (Ma1e=28) who were diagnosed as atrial flutter without previous atrial fibrillation history were enrolled in this study. Group 1 (n=11) was defined as those who developed atrial fibrillation after atrial flutter ablation during 1 year follow-up. Group 2 (n=25) was defined as those who has not occurred atrial fibrillation during same follow-up term. Echocardiogram was performed to all patients. We measured left atrial size, left ventricle end diastolic and systolic dimension, ejection fraction and left atrial volume index before and after ablation of atrial flutter. The differences of each variables were compared and analyzed between two groups. Results : The preablation left ventricular ejection fraction (preLVEF) and postablation left ventricular ejection fraction (postLVEF) are 54±14%, 56±13% in group 1 and 47±16%, 52±13% in group 2. The differences between each two groups are statistically insignificant (2.2±1.5 in group 1 vs 5.4±9.8 in group 2, p=0.53). The preablation left atrial size (preLA) and postablation left atrial size (postLA) are 40±4 mm, 41±4 mm in group1 and 44±8 mm, 41±4 mm in group 2. The atrial sizes of both groups were increased but, the differences of left atrial size between two groups before and after flutter ablation were statistically insignificant (0.6±0.9 mm in group 1 vs -3.8±7.4 mm in group 2, p=0.149). The left atrial volume index before flutter ablation was significantly reduced in group 1 than group 2 (32±10 mm³/m², 35±10 mm³/m² in group 1 and 32±10 mm³/m², 29±8 mm³/m² in group 2, p<0.05). Conclusion : The difference between left atrial volume index before and after atrial flutter ablation is the robust predictor of occurrence of atrial fibrillation after atrial flutter ablation without previous atrial fibrillation.

심장세동의 수술요법

김기봉,이창하,손대원,Kim, Gi-Bong,Lee, Chang-Ha,Son, Dae-Won 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.3

심방세동은 가장 흔한 부정맥 질환으로서,특히 승모판막 질환이 있는 경우에는 60%에 이르는높은 빈도의 유병율을 보이는데,심방세동 환자의 약 113에서 혈전 색전증을 일으키고,혈전 색전증이 생긴 환자의 약 60%에서는 사망에 이르거나 심각한 합병증이 초래되므로 심장질환에 대한 수술시,동반 심 방세동에 대한 적극적 인 치료가 고려되어야 한다. 서울대학교병원 흉부외과학교실에서는 1994년 4월부터 1995년 6월까지 심방세동을 동반한 심장질환 을 가진 20명의 환자에서 Maze 술식을 포함한 개심술을 시행하였다 대상환자들의 남녀 성비는 남 '녀 : 6 : 14 이 었으며, 평균연령은 48$\pm$11세 (31 ~66세) 였다. 1년이상 지 속된 만성 심방세동이 14례(70%)였고, 1년미만인 경우가 6례(30%)였으며,심방세동의 과거력은 평균 36$\pm$42개월(1~132개월)이었다. 수술전 혈전전색증의 과거력이 있었던 경우가 7례(35%), 좌심방내에 혈전이 있었던 경우가 9례(45%)였다. 동반 심장질환으로는 판막질환이 19례,심실중격결손증이 1례였 으며, Maze술식과 더불어 승모판막 및 대동맥판막 치환술이 5례, 승모판막 치환술을 시행한 경우가 4 fl, 승모판막 치환술 및 삼첨판\ulcorner 성형술 4례, 승모판막 성형술 3례, 승모판막 성형술 및 삼첨판막 성형 술이 1례, 승모판막 치환술 및 관상동맥 우회술이 1례, 대동맥판막 치환술 1례, 심실중격결손봉합술이 1례 였다. 대동맥차단시간은 평균 175 :41분(116~270분)이었다. 수술과 관련된 사망은 없었으며, 수술 후 심방세동의 재발이 16명(80%)에서 있었으나, 수술후 평균 41일째 규칙적인 심박동 소견을 보였다. 수술후 합병증으로서는 저심박출증을 보였던 경우가 3례 (15%), 술전 존재하였던 반신불수의 악화가 1 례, 그리고 급성 신부전이 1례씩 관찰되었다. 20명의 외래추적 관찰기간은 평균 16.5개월(10.5~24개월) 이었는데, 외래 추적기간 중 모든 환자에서 규칙적인 심박동의 소견을 보였으며, 정상 동방결절리듬을 보인 경우 17례 (85%)중에서 항부정맥제의 투여가 필요 없는 경우가 13례 (76%)이고 나머지 4례에서는 항부정맥제를 투여중이며, 접합부 율동을 보이는 3례 (15%) 중 2례에서는 항부정맥제를 투.i중이고, 1 례는 접합부 서맥으로 인공심박동기 (DDD-R type : AAI mode)의 삽입이 필요했다. 추적기간 중에 심에 코검사는 19명에서 시행하였는데, 우심방 수축력이 보이는 경우가 1 례 (95%) 이었고, 좌심방 수축력은 12례 (63%)에서 명백히 관찰되 었다. 심장질환에 대한 개심술시 Maze술식을 동반시행할 경우심장허혈시간이 길어지는 단점이 있으나, 최근의 발달된 심근보호법의 적용으로 수술에 따른 위험을 최소화할 수 있으므로 심방세동의 적극적 인 치료를 고려하여야 할 것으로 사료된다. .Itrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze 111 procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defEct (VSD). Mean duration of atrial fibrillation was 36 months (:42 months) (range, 1 to 132 months). T e past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombus was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVd and tricuspid annuloplasty(TAP) in 4, mitral valvuloplasty(Mln) in 3, Mln and Tln in 1, MIW and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, but, recurrent atrial fibrillation was converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegic in 1, and acute renal failure in 1. Mean follow-up interval of patient was 16.5 months (range, 10.5 to 24 months) and all patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Boris Leithäuser,Jai-Wun Park 대한심장학회 2009 Korean Circulation Journal Vol.39 No.11

Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis. Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.

발작성 심방세동에서 TEI index의 변화

박종필 ( Jong Pil Park ),정금모 ( Keum Mo Jung ),전성희 ( Sung Hee Jeon ),이윤정 ( Yun Jung Lee ),최현종 ( Hyung Jong Choi ),김남돈 ( Nam Don Kim ),김용진 ( Yong Jin Park ),김남호 ( Nam Ho Kim ),박우석 ( Woo Seok Pakr ),류제영 ( J 전북대학교 의과학연구소 2003 全北醫大論文集 Vol.27 No.2

연구배경: 심방세동은 심방의 확장과 심실 기능이 저하된 경우에 자주 동반되는 비교적 흔한 부정맥이다. 하지만 심방세동의 병인에 대해서는 아직 명확하지 않다. 본 연구는 발작성 심방세동을 갖는 환자에서 도 플러 심근능력 지표 (Tei index)을 이용하여 심실 기능을 평가하고자 하였다. 방법: 발작성 심방세동을 갖는 환자 25명(남 14, 여 11, 61±3세)과 대조군 25명 (남 11, 여 14, 58±10세)을 대상으로 하였으며, 75세 이상의 고령 환자, 고혈압, 당뇨, 관상 동맥질환, 판막질환을 갖는 환자는 제외하였다. Tei index는 isovolumetric contraction time (ICT)과 isovolumetric relaxation time (IRT)를 ejection time (ET) 으로 나눈값으로 정의하였다. 결과: 양 군 간에 임상적인 양상은 큰 차이가 없었고. 심 초음파상 심실 중격 두께(8.9±1.8 vs 11.6±3.2 mm, p<0.05), 좌심실 질량지수 (85.6±45 vs 107±33 g/m2, p<0.05), 는 발작성 심방 세동군에서 의의 있게 높았다. 좌심실의 확장기말 길이 (49±4 vs 51±4 mm), 수축가말 길이 (29.7±3 vs 33.1±5 mm), 좌심실 구혈률(69±6 vs 65±8%)은 유의한 차이가 없었다. 좌심방의 전후 길이 (32.8±4.3 vs 39.5±8.2 mm, p<0.05),은 발작성 심방세동 군에서 의의 있게 높았으며 좌심방면적 분획변화율(fractional area change)은 (39.5±8.2 vs 32.8±4.3%, p<0.05),은 의의 있게 낮았다. 발작성 심방세동 군에서 IRT (59±23 vs 76.5±21 msec, p<0.05),는 길었으며, ET (332.9±23 vs 303±27 msec, p<0.05),는 짧았다. ICT (43±21 vs 53±17 msec)는 통계학적으로 차이가 없었다. Tei index (0.33±0.01 vs 0.4±0.12, p<0.05)는 발작성 심방세동 군에서 의의 있게 높았다. 결론: 본 연구에서 발작성 심방세동의 병인에 있어서 좌심방의 기능 저하뿐만 아니라, 좌심실의 이완기 장애 도한 중요한 역할을 하고 있음을 알 수 있었다. Background and Objective : Atrial fibrillation is comparative common arrhythmia, when left atrium is enlarged and the ventricular function of the heart is fallen. However, cause of a Atrial fibrillation is not confirmed. This research wished to evaluate the function of the ventricle using Doppler myocardial performance index (Tei index) in patient who have paroxysmal atrial fibrillation. Subjective and Method : This study was done with 25 people (man 14, woman 11, age: 61 ±8 yr) who had paroxysmal atrial fibrillation and 25 people (man 11, woman 14, age: 58 ±10) who had no abnormality(control group). Among the researched patient, who have advanced age more than 75 years old, high blood pressure, diabetes, coronary arteries disease, valvular heart disease were excluded. Myocardial performance index(Tei index) defined by value that divide isovolumetric contraction time(ICT) and isovolumetric relaxation time(IRT) by ejection time (ET). Results : In aspect about clinical characteristics, the LV septal wall thickness(8.9 ±1.8vs 11.6 ±3.2 mm, p<0.05) and LV mass index (86±45 vs 107±33 g/m2, <0.05) were significantly higher in paroxysmal atrial fibrillation group than control group. The differences in LV end diastolic diameter (49±4 vs 51±4 mm), end-systolic diameter (29±7 vs 33±1 mm), left ventricle ejection (69±4 vs 65±5 %) between two groups were not statistically different. In paroxysmal atrial fibrillation group, LAAP diameter (33.1±4 vs 39.6±8.2 mm, p<0.05) was significantly long, left atrial fractional shortening (41±6 vs 36±6 %, p<0.05) was significantly low. In paroxysmal atrial fibrillation group, the isovolumetric relaxation time(IRT) was significantly long (59±22 vs 76±21 msec, p<0.05) and ejection time(ET) was significantly short (333±23 vs 303±28 msec, p<0.05). Isovolumetric contraction time(ICT) was not statistically different (43±21 vs 53±17 msec). Doppler Myocardial performance index(Tei index) was significantly high in paroxysmal atrial fibrillation group(0.30±0.1 vs 0.42±0.12, p<0.05). Conclusion : As result of this research, we can know that there is diastolic dysfunction of left ventricle as well as depression of left atrial function at paroxysmal atrial fibrillation and diastolic dysfunction of left ventricle can be a cause of paroxysmal atrial fibrillation.

만성 비판막성 심방세동의 전기적 심율동전환후 장기 추적관찰 성적

전성희(Seong Hee Jeon),현민수(Min Su Hyon),이상훈(Sang Hoon Lee),조성제(Sung Je Cho),고경환(Kyung Whan Ko),윤재형(Jae Hyung Yoon),이수금(Su Geum Lee),김명아(Myung A Kim),박성훈(Seong Hoon Park) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A Objectives : We performed a prospective observation for the patients with chronic nonvalvular atrial fibrillation who underwent electrical cardioversion after failed pharmacological cardioversion with amiodarone. The aim of this study was to look at the immediate sinus conversion rate, the maintenance rate of sinus rhythm at long-term follow-up, and the clinical and echocardiographic parameters that influence on the rate of immediate sinus conversion and maintenance of sinus rhythm. At simultaneously, we intended to evaluate the efficacy of electrical cardioversion for the patients with chronic nonvalvular atrial fibrillation. Methods : After anticoagulation therapy with coumadine for four weeks before cardioversion, we tried pharmacological cardioversion with amiodarone first. Failed cases included in this study. The direct current cardioversion was performed under transesophageal echocardiography monitoring to exclude the left atrial thrombus and to measure various echocardiographic parameters. After successful sinus cardioversion, we prescribed amiodarone with maintenance doses and coumadine at least 4 weeks. Transthoracic echocardiography was performed before cardioversion and one day, one month, 3 months, 6 months, and 9 months after sinus conversion. The minimum duration of atrial fibrillation was one month before the trial of pharmacological cardioversion. Results : 1) The total number of patients was forty three (male : 28, female : 15, average age : 60±9). The initial success rate of sinus conversion was 88 %. 2) The maintenance rate of sinus rhythm with maintenance dose of amiodarone was 52 % after 9 months follow-up. 3) The direct current cardioversion was performed to 10 patients among 17 patients who recurred atrial fibrillation after sinus conversion. Among 10 patients, 5 patients of them were converted to sinus rhythm and maintained sinus rhythm after 9 months follow-up. 4) The initial success rate of sinus conversion was significantly higher in patients with lone atrial fibrillation compared with those patients with other associated heart disease (100 % vs. 83 %, p < 0.05), but the long-term maintenance rate of sinus rhythm was not influenced by the presence of associated disease. 5) The duration of atrial fibrillation before cardioversion was shorter in patients who were naintained sinus rhythm than that of those who were recurred atrial fibrillation. 6) The initial energy requirement at sinus conversion was lower in the patients who were maintained sinus rhythm than that of those who were recurred atrial fibrillation at 9 months follow-up. Conclusions : Direct current cardioversion was an effective treatment modality for patients with chronic nonvalvular atrial fibrillation after failure of pharmacological cardioversion with amiodarone.

심방세동 환자에서 항부정맥제 Ic drug인 Propafenone과 Flecainide의 drug Efficacy

김동수,고충원,조홍근,김태용,안신기,이문형,김성순 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.9

심방세동 환자의 질병관련 지식 정도

김경희,송주현,신승용 한국융합학회 2021 한국융합학회논문지 Vol.12 No.6

본 연구는 심방세동 환자를 대상으로 심방세동 질병관련 지식 정도를 파악하고자 시도되었다. 지식측정을 위해 JAKQ와 KAFSP 측정 도구를 사용하였으며, 222명의 대상자가 설문지에 응답하였다. JAKQ와 KAFSP의 평균 점수는 각 54.7점, 18.5점이었으며. 심방세동 환자들은 대체로 심방세동이 뇌졸중을 유발하며, 혈전 예방을 위해 항응고제를 복용해야 하는 점에 대해 잘 알고 있었으나, 항응고제 복용 시 주의사항과 심방세동의 증상 및 치료법에 대한 지식은 부족하였다. 항응고요법에 따른 심방세동 질병관련 지식 점수는 통계적으로 유의한 차이는 없으며, VKA 관련 지식의 정도가 낮았다. 또한, JAKQ와 KAFSP 모두 교육수준에 따른 심방세동 질병관련 지식 점수는 통계적으로 유의한 차이 가 있었다. 이러한 결과를 바탕으로 심방세동 환자의 지식 향상을 위해 맞춤형 교육프로그램 개발이 필요함을 알 수 있다. The aim of this study was to determine the level of knowledge related to disease in patients with atrial fibrillation. We used the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) and Knowledge of Atrial Fibrillation and Stroke Prevention Questionnaire(KAFSP). A total of 222 AF patients completed the JAKQ and KAFSP. The mean score of the JAKQ and KAFSP 54.7 and 18.5 points, respectively. In general, patients with Atrial fibrillation were well aware that atrial fibrillation causes stroke and that anticoagulants should be taken to prevent blood clots. However, they were not well aware of the precautions for taking anticoagulants, symptoms of atrial fibrillation, and treatment of atrial fibrillation. There was no statistically significant difference in atrial fibrillation knowledge score according to anticoagulants but the degree of knowledge related to VKA was low in patients taking VKA. The both score of JAKQ and KAFSP had significant differences in atrial fibrillation knowledge depending on the level of education. Based on these finding, it is necessary to develop a customized education program in order to improve the knowledge of patients with atrial fibrillation.

The ratio of early transmitral flow velocity (<i>E</i>) to early mitral annular velocity (<i>E</i>_m) predicts improvement in left ventricular systolic and diastolic function 1 year after catheter ablation for atrial fibrillation

Kim, In-Soo,Kim, Tae-Hoon,Shim, Chi-Young,Mun, Hee-Sun,Uhm, Jae Sun,Joung, Boyoung,Hong, Geu-Ru,Lee, Moon-Hyoung,Pak, Hui-Nam Oxford University Press 2015 Europace Vol.17 No.7

<P><B>Aims</B></P><P>Successful rhythm control after atrial fibrillation catheter ablation is known to induce left atrial reverse remodelling and improve left ventricular (LV) function. We explored the clinical factors affecting LV systolic and diastolic function 1-year after catheter ablation for atrial fibrillation.</P><P><B>Methods and results</B></P><P>We compared pre-procedural and 1-year follow-up echocardiograms in 521 patients with atrial fibrillation who underwent catheter ablation. Left ventricular systolic function was estimated by the ejection fraction (EF); diastolic function was estimated by the ratio of early transmitral flow velocity (<I>E</I>) to early mitral annular velocity (<I>E</I><SUB>m</SUB>). (i) Catheter ablation of atrial fibrillation significantly reduced left atrium volume index (<I>P</I> < 0.001) and improved LV EF both in patients with recurrent atrial fibrillation (<I>n</I> = 133, <I>P</I> = 0.008) and those without recurrence (<I>n</I> = 388, <I>P</I> < 0.001). (ii) Follow-up EF was significantly improved in patients with baseline <I>E</I>/<I>E</I><SUB>m</SUB> < 15 (<I>n</I> = 454, <I>P</I> < 0.001), whereas <I>E</I>/<I>E</I><SUB>m</SUB> was significantly reduced in patients with pre-procedural <I>E</I>/<I>E</I><SUB>m</SUB> ≥ 15 (<I>n</I> = 67, <I>P</I> = 0.008). (iii) Baseline <I>E</I>/<I>E</I><SUB>m</SUB> < 15 (<I>β</I> = −3.854, 95% CI −5.99 to −1.72, <I>P</I> < 0.001), baseline EF <50% (<I>β</I> = 10.586, 95% CI 7.55 to 13.63, <I>P</I> < 0.001), and female (<I>β</I> = −1.726, 95% CI −3.36 to −0.10, <I>P</I> = 0.038) were independently associated with improved EF. Baseline <I>E</I>/<I>E</I><SUB>m</SUB> ≥ 15 (<I>β</I> = 4.896, 95% CI 3.45 to 6.34, <I>P</I> < 0.001) and younger age (<I>β</I> = −0.066, 95% CI −0.11 to −0.02, <I>P</I> = 0.003) were independent factors associated with improved <I>E</I>/<I>E</I><SUB>m</SUB>.</P><P><B>Conclusion</B></P><P>Pre-procedural <I>E</I>/<I>E</I><SUB>m</SUB> predicted improvement in LV systolic and diastolic functions 1 year after catheter ablation for atrial fibrillation. Low baseline <I>E</I>/<I>E</I><SUB>m</SUB> was independently associated with improved EF, while high <I>E</I>/<I>E</I><SUB>m</SUB> predicted improvement in LV diastolic function.</P>