Abstract
Purpose: To investigate the alteration of left ventricular function in subjects with persistent atrial tachyarrhythmia induced cardiomyopathy (TIC) undergoing radiofrequency ablation, and to study the pathogenesis and effective treatment of TIC. Methods: A total of 25 cases with persistent atrial tachyarrhythmia and impaired left ventricular systolic function were studied (16 men and 9 women, aged 53.3 ± 15.2 years), and all subjects underwent electrophysiological study and radiofrequency ablation of atrial tachyarrhythmia under the guidance of CARTO system during 2006.9-2011.8. Indexes related to cardiac function, including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), New York Heart Association functional classification (NYHA class), 6 minutes walking test (6MWT), N-terminal pro-brain natriuretic peptide (BNP) and 24 hours average heart rate (AHR), were analyzed at the time point of 7 days, 3 and 6 months after the procedure as well as 1 day before ablation. Results: No refractory atrial arrhythmia recurred in all cases after ablation, compared with LVEDD (51.7 ± 4.5 mm), LVEF (39.0% ± 4.3%), number of patients with NYHA class IV and III (n = 17), 6MWT (212 ± 56 m), BNP (3622 ± 1860 ng/L) and AHR (112.5 ± 23.2 bpm) before ablation, the index of LVEDD (45.2 ± 3.3 mm; 41.7 ± 2.5 mm; 40.5 ± 3.1 m), BNP (2429 ± 1355 ng/L; 1530 ± 866 ng/L; 1300 ± 520 ng/L), total number of patients of NYHA class IV and III (n = 11; 3; 2) and AHR (73.3 ± 15.3 bpm; 68.7 ± 13.5 bpm; 66.3 ± 13.6 bpm) significantly decreased (P 47 m; 305 ± 37 m; 313 ± 41 m) greatly increased (P ）in 7 days, 3 and 6 months after ablation respectively. There was a statistical difference between 7 days and 3 or 6 months after ablation in above-mentioned indexes (P P > 0.05), no significant difference existed between 3 and 6 months in all indexes (P > 0.05). Conclusion: long-lasting atrial arrhythmia with rapid ventricular response could impair left ventricle function, which could be reversed within weeks after successful ablation and restoration of sinus rhythm.
Highlights
Atrial tachyarrhythmia is one of the most common encountered problems in clinical practice, long lasting of which could result in tachycardia-induced cardiomyopathy (TIC) [1], presenting cardiac enlargement and impaired left ventricular systolic function, similar to that of idiopathic dilated cardiomyopathy (IDC) [2]
atrial fibrillation (AF) converted into sinus rhythm spontaneously during the process of CPVI and the other 10 cases required direct current cardioversion to restore SR, bottom line and cavotricuspid line were created in 4 and 3 cases respectively. 7 atrial flutter patients underwent right atrial cavotricuspid isthmus linear ablation, of which 6 were counter clockwise (CCW) and 1 was clockwise (CW) isthmus-dependent activation
For patients with atrial tachycardia, 2 cases originated from crista terminalis (CT) and the other one arising from superior vena cava (SVC)
Summary
Atrial tachyarrhythmia is one of the most common encountered problems in clinical practice, long lasting of which could result in tachycardia-induced cardiomyopathy (TIC) [1], presenting cardiac enlargement and impaired left ventricular systolic function, similar to that of idiopathic dilated cardiomyopathy (IDC) [2]. Patients with IDC are susceptible to develop atrial arrhythmia due to increased intra-atrium pressure [3], which in turn further deteriorate the cardiac function and cause refractory heart failure [4]. The aim of this study was to investigate the impact of atrial tachyarrhythmia on left ventricular function and its alteration after elimination of atrial arrhythmia by means of radiofrequency ablation in 25 patients who already received optimized medication for heart failure, and to study the role of ablation in the treatment of TIC
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