Impact of diastolic dysfunction on the outcome of catheter ablation in patients with atrial fibrillation

Objective: To evaluate the impact of diastolic dysfunction on the outcome of atrial fibrillation (AF) ablation.

Methods: Eighty consecutive patients with drug-refractory symptomatic AF who underwent AF ablation were enrolled (65 males, 58 ± 10 years, 65 paroxysmal AF, 15 persistent AF). All patients underwent extensive pulmonary vein isolation with a double lasso technique using CARTO MERGE. Diastolic dysfunction was defined as a ratio of the mitral inflow early filling velocity to the velocity of the early medial mitral annular ascent of >10. The clinical and echocardiographic data were compared between the patients with and without diastolic dysfunction, and between the patients with and without AF recurrences after the AF ablation.

Results: Twenty-nine out of all the patients (36.3%) had diastolic dysfunction. Compared with the patients without diastolic dysfunction, the patients with diastolic dysfunction had higher brain natriuretic peptide (p=0.001) and C-reactive protein (p=0.023) levels, and a larger left atrial diameter (P=0.019). The AF-free rate after a single or repeat AF ablation procedure in the patients with diastolic dysfunction was lower than that in those without diastolic dysfunction (p=0.005 and p=0.013 by the log-rank test, respectively). In the univariate analysis, the patients with persistent AF and diastolic dysfunction were likely to have AF recurrences after a single AF ablation. The multivariate analysis indicated diastolic dysfunction as the only independent predictor of an AF recurrence after a single AF ablation (P=0.023).

Conclusion: The patients with diastolic dysfunction had a worse outcome of the AF ablation not only for a single procedure but also a repeat procedure.