Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients

Abstract

Introduction: Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients. Purpose: The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD. Methods: This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and <11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA. Results: 28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p<0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P<0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p<0.01 respectively). In the patients without DD (the group of E/e’<11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P<0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p<0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P<0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity. Conclusion: CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.