Right Ventricular Dysfunction in Patients with Symptomatic Atrial Fibrillation: Prevalence and Functional Implications

BackgroundAssessment of left ventricular (LV) function is an essential component of guideline-recommended management of atrial fibrillation (AF).However, the role and implications of right ventricular (RV) dysfunction in AF is poorly understood. ObjectiveTo determine the prevalence of RV dysfunction and evaluate its association with cardiorespiratory fitness (CRF) and symptom burden in patients with symptomatic AF. MethodsConsecutive adults with symptomatic paroxysmal or persistent AF and preserved LV ejection fraction scheduled for catheter ablation underwent transthoracic echocardiography, cardiopulmonary exercise testing and AF symptom assessment.RV dysfunction was defined as tricuspid annular plane systolic excursion 1.7cm and/or tissue Doppler s' velocity 9.5cm/s.Cardiorespiratory fitness was determined by peak oxygen consumption (VO 2peak ) during cardiopulmonary exercise testing. ResultsAmong 241 patients (mean age 6610 years; 25% female), RV dysfunction was present in 35 patients (14.5%) despite preserved LV systolic function.Patients with RV dysfunction had lower CRF (VO 2peak 17.96.7 vs 21.16.6mL/kg/min,p=0.01) independent of rhythm, with a greater proportion exhibiting severely reduced CRF (VO 2peak <16mL/kg/min: 43% vs 23%, p=0.026).There was no association between RV dysfunction and AF symptom severity (p=0.59).Structural chamber dimensions were comparable.Patients with RV dysfunction demonstrated higher E/e' (p=0.006),lower left atrial reservoir strain (p<0.001) and LV global longitudinal strain (p<0.001).