Left ventricular diastolic dysfunction in endovascular treatment of atrial fibrillation in patients with preserved ejection fraction

Aim. To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF). Materials and methods. 109 patients with paroxysmal (n=90; 82.6%) and persistent (n=19; 17.4%) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months. Results. After the surgery, 61 (56.5%) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5%). At baseline, LVDD with SR was observed in 53 patients (48.6%), at 6 months - in 34 (31.2%) patients (p=0.001), and at 12 months - in 27 patients (24.8%) (p<0.001). In Group 1, the early LV filling velocity (peak E) was statistically significantly increased (p<0.001); the E/A ratio recovered (p<0.001); and mitral septal (e’ septal) (p=0.001) and lateral (e’ lateral) (p=0.03) annulus motion velocities were increased. Such changes in parameters did not occur in the group of patients with a relapse of AF. The increased velocity of peak E at 12 months of surgery statistically significantly influenced the absence of AF relapse (p=0.021). Conclusion. Approximately a half of patients with paroxysmal or persistent AF had LVDD. In patients who maintained SR following pulmonary vein catheter isolation, parameters of LV diastolic function recovered.