July 1, 1998Open Access
View Full PaperResolution of cardiomyopathy after ablation of atrial flutter
Key Result
Radiofrequency catheter ablation of atrial flutter in patients with cardiomyopathy significantly improved mean LVEF from 30.9% to 41.3% at 7 months (p=0.005).
Study Design
Type
Observational (n=11)
Structured PICO
Does radiofrequency ablation of atrial flutter improve left ventricular ejection fraction in patients with atrial flutter and dilated cardiomyopathy?
P
Population
11 male patients (mean age 59 +/- 8 years) with atrial flutter, dilated cardiomyopathy (LVEF <50%), and congestive heart failure symptoms, selected from a consecutive series of 59 patients.
I
Intervention
Radiofrequency ablation (RFA) of atrial flutter
O
Outcome
Left ventricular ejection fraction (LVEF) assessed by two-dimensional echocardiographysurrogate
Radiofrequency ablation of atrial flutter in patients with concurrent cardiomyopathy significantly improves left ventricular ejection fraction and heart failure symptoms, suggesting tachycardia-induced cardiomyopathy is a reversible cause of LV dysfunction in this population.
Main Result
Absolute Event Rate: 41.3% vs 30.9%
p-value: p=0.005
Abstract
OBJECTIVES: We sought to serially assess left ventricular (LV) function before and after catheter ablation of atrial flutter (AFI). BACKGROUND: The relation of tachycardia-induced cardiomyopathy to AFI and its response to direct catheter ablation are unknown. METHODS: LV function was assessed in a series of 59 consecutive patients with successful radiofrequency ablation (RFA) of AFI before and after the procedure. Eleven patients had dilated cardiomyopathy (LV ejection fraction LVEF <50%) and congestive heart failure (CHF) symptoms and are the subject of this report. LV function was assessed by LVEF on two-dimensional echocardiography and functional status by New York Heart Association (NYHA) CHF classification. RESULTS: Patients were 59 +/- 8 years old, and were all male. Five patients had a preablation diagnosis of idiopathic cardiomyopathy. The preablation LVEF was 30.9 +/- 11.0% and improved to 41.3 +/- 16% (p = 0.005) when measured 7 months after successful ablation. NYHA CHF class improved from 2.6 +/- 0.5 to 1.6 +/- 0.9 (p = 0.002). Six (55%) of 11 patients had normalization of the LVEF, with complete resolution of CHF symptoms. A lower preablation LVEF and functional class predicted nonresolution of dilated cardiomyopathy (p = 0.002 and 0.001, respectively). CONCLUSIONS: Restoration of normal sinus rhythm by RFA in patients with chronic AFI and cardiomyopathy substantially improved LV function. Resolution of dilated cardiomyopathy occurred in the majority of patients. Tachycardia-induced cardiomyopathy may be a more common mechanism of LV dysfunction in patients with AFI than expected, and aggressive treatment of this arrhythmia should be considered.