WJCD  Vol.3 No.9 , December 2013
Improvement of left ventricular function in patients with persistent atrial tachyarrhythmia induced cardiomyopathy undergoing radiofrequency ablation
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 < 0.05), LVEF (45.6 ± 3.5%; 51.5 ± 2.7%; 53.5 ± 3.1%) and 6MWT (262 ±

47 m; 305 ± 37 m; 313 ± 41 m) greatly increased (P < 0.05in 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 < 0.05) except AHR (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.


Cite this paper
Shi, X. , Shan, Z. , Guo, H. and Wang, Y. (2013) Improvement of left ventricular function in patients with persistent atrial tachyarrhythmia induced cardiomyopathy undergoing radiofrequency ablation. World Journal of Cardiovascular Diseases, 3, 529-535. doi: 10.4236/wjcd.2013.39084.
References
[1]   Miyasaka, Y., Barnes, M.E., Gersh, B.J., Cha, S.S., Bailey, K.R., Abhayaratna, W.P., Seward, J.B. and Tsang, T.S. (2006) Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114, 119-125.
http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595140

[2]   Bounhoure, J.P., Boveda, S., Albenque, J.P., et al. (2006) Arrhythmia-induced dilated cardiomyopathies. Bulletin del Academie de Nationale de Medecine, 190, 1225-1235.

[3]   Ehrlich, J.R., Nattel, S. and Hohnloser, S.H. (2002) Atrial fibrillation and congestive heart failure: Specific considerations at the intersection of two common and important cardiac disease sets. Journal of Cardiovascular Electrophysiology, 13, 399-405.
http://dx.doi.org/10.1046/j.1540-8167.2002.00399.x

[4]   Grogan, M., Smith, H.C., Gersh, B.J. and Wood, D.L. (1992) Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. The American Journal of Cardiology, 69, 1570-1573.
http://dx.doi.org/10.1016/0002-9149(92)90705-4

[5]   De Ponti, R., Cappato, R., Curnis, A., et al. (2006) Transseptal catheterization in the electrophysiology laboratory: Data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47, 1037-1042. http://dx.doi.org/10.1016/j.jacc.2005.10.046

[6]   Mclaran, C.J., Gersh, B.J., Sugrue, D.D., et al. (1985) Tachycardia induced myocardial dysfunction. A reversible phenomenon? British Heart Journal, 53, 323-327.
http://dx.doi.org/10.1136/hrt.53.3.323

[7]   Khasnis, A., Jongnarangsin, K., Abela, G., et al. (2005) Tachycardia-induced cardiomyopathy: A review of literature. Pacing and Clinical Electrophysiology, 28, 710-721. http://dx.doi.org/10.1111/j.1540-8159.2005.00143.x

[8]   Scheinman, M.M. (1998) Atrial fibrillation and congestive heart failure: The intersection of two common dis eases. Circulation, 98, 941-942.
http://dx.doi.org/10.1161/01.CIR.98.10.941

[9]   Umana, E., Solares, C.A. and Alpert, M.A. (2003) Tachy cardia-induced cardiomyopathy. The American Journal of Medicine, 114, 51-55.
http://dx.doi.org/10.1016/S0002-9343(02)01472-9

[10]   Simantirakis, E.N., Koutalas, E.P. and Vardas, P.E. (2011) Arrhythmia-induced cardiomyopathies: The riddle of the chicken and the egg still unanswered?” Europace, 14, 466-473. http://dx.doi.org/10.1093/europace/eur348

[11]   Fenelon, G., Wijns, W., Andries, E. and Brugada, P. (1996) Tachycardiomyopathy: Mechanisms and clinical implications. Pacing and Clinical Electrophysiology, 19, 95-106.
http://dx.doi.org/10.1111/j.1540-8159.1996.tb04796.x

[12]   Shinbane, J.S., Wood, M.A., Jensen, D.N., Ellenbogen, K.A., Fitzpatrick, A.P. and Scheinmann, M.M. (1997) Tachycardia-induced cardiomyopathy: A review of ani-mal models and clinical studies. Journal of the American College of Cardiology, 29, 709-715.
http://dx.doi.org/10.1016/S0735-1097(96)00592-X

[13]   Moe, G.W., Montgomery, C., Howard, R.J., et al. (1993) Left ventricular myocardial blood flow, metabolism and effects of treatment with enalapril: Further insights into the mechanisms of canine experimental pacing-induced heart failure. Journal of Laboratory and Clinical Medicine, 121, 294-301.

[14]   Iyer, V.R. (2008) Ventricular dysfunction: Tachycardiainduced cardiomyopathy. Indian Pacing and Electrophysiology Journal, 8, S122-S129.

[15]   Redfield, M.M., Kay, G.N., Jenkins, L.S., et al. (2000) Tachycardia related cardiomyopathy: A common cause of ventricular dysfunction in patients with atrial fibrillation refered for AV node ablation. Mayo Clinic Proceedings, 75, 790-795. http://dx.doi.org/10.4065/75.8.790

[16]   Freudenberger, R.S., Wilson, A.C. and Kostis, J.B. (2007) Comparison of rate versus rhythm control for atrial fibrillation in patients with left ventricular dysfunction (from the AFFIRM Study). American Journal of Cardiology, 100, 247-252.
http://dx.doi.org/10.1016/j.amjcard.2007.02.101

[17]   Khan, M.N., Jais, P., Cummings, J., et al. (2008) Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. The New England Journal of Medicine, 359, 1778-1785. http://dx.doi.org/10.1056/NEJMoa0708234

[18]   Verma, A., Macle, L., Cox, J., et al. (2011) CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: Catheter ablation for atrial fibrillation/atrial flutter. Canadian Journal of Cardiology, 27, 60-66.
http://dx.doi.org/10.1016/j.cjca.2010.11.011

[19]   Bourke, J., Dunuwille, A., O’Donnell, D., et al. (2005) Pulmonary vein ablation for idiopathic atrial fibrillation: Six month outcome of first procedure in 100 consecutive patients. Heart, 91, 51-57.
http://dx.doi.org/10.1136/hrt.2003.023093

[20]   Ehrlich, J.R., Nattel, S. and Hohnloser, S.H. (2002) Atrial fibrillation and congestive heart failure: Specific considerations at the intersection of two common and important cardiac disease sets. Journal of Cardiovascular Electrophysiology, 13, 399-405.
http://dx.doi.org/10.1046/j.1540-8167.2002.00399.x

[21]   Hsu, L.F., Jais, P., Sanders, P., et al. (2004) Catheter ablation for atrial fibrillation in congestive heart failure. The New England Journal of Medicine, 351, 2373-2383.
http://dx.doi.org/10.1056/NEJMoa041018

[22]   Chen, M.S., Marrouche, N.F., Khaykin, Y., et al. (2004) Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. Journal of the American College of Cardiology, 43, 1004-1009.
http://dx.doi.org/10.1016/j.jacc.2003.09.056

[23]   Scheuemeyer, F.X., Grafstein, E., Heilbron, B., et al. (2011) Emergency department management and 1-year outcomes of patients with atrial flutter. Annals of Emergency Medicine, 57, 564-571.
http://dx.doi.org/10.1016/j.annemergmed.2010.09.027

[24]   Zhao, Z., Li, X. and Guo, J. (2009) Electrophysiological characteristics of atrial tachycardia originating from the superior vena cava. Journal of Interventional Cardiac Electrophysiology, 24, 89-94.
http://dx.doi.org/10.1007/s10840-008-9324-0

 
 
Top