Korean Circ J.  2024 Apr;54(4):203-217. 10.4070/kcj.2023.0312.

The Effects of Radiofrequency Catheter Ablation for Atrial Fibrillation on Right Ventricular Function

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 3Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background and Objective
The effects of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) on right ventricular (RV) function are not well known.
Methods
Patients who underwent RFCA for AF and underwent pre- and post-procedural echocardiography were enrolled consecutively. Fractional area change (FAC), RV free-wall longitudinal strain (RVFWSL), and RV 4-chamber strain including the ventricular septum (RV4CSL) were measured. Changes in FAC, RVFWSL, and RV4CSL before and after RFCA were compared among paroxysmal AF (PAF), persistent AF (PeAF), and long-standing persistent AF (LSPeAF) groups.
Results
A total of 164 participants (74 PAF, 47 PeAF, and 43 LSPeAF; age, 60.8 ± 9.8 years; men, 74.4%) was enrolled. The patients with PeAF and LSPeAF had worse RV4CSL (p<0.001) and RVFWSL (p<0.001) than those with PAF and reference values. Improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared with the PAF and LSPeAF groups (ΔRV4CSL, 8.4% [5.1, 11.6] in PeAF vs. 1.0% [−1.0, 4.1] in PAF, 1.9% [−0.2, 4.4] in LSPeAF, p<0.001; ΔRVFWSL, 9.0% [6.9, 11.5] in PeAF vs. 0.9% [−1.4, 4.9] in PAF, 1.0% [−1.0, 3.6] in LSPeAF, p<0.001). In patients without recurrence, improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared to the LSPeAF group.
Conclusions
RV systolic function is more impaired in patients with PeAF and LSPeAF than in those with PAF. RV systolic function is more improved after RFCA in patients with PeAF than in those with PAF or LSPeAF.

Keyword

Atrial fibrillation; Catheter ablation; Right ventricle; Strain; Ventricular function, right

Figure

  • Figure 1 Right ventricular strain analysis using vendor-independent analysis software.

  • Figure 2 Changes in RV function as measured by FAC, RV4CSL, and RVFWSL before and after RFCA are shown for groups of PAF, PeAF, and LSPeAF in total population.FAC = fractional area change; LSPeAF = long-standing persistent atrial fibrillation; PAF = paroxysmal atrial fibrillation; PeAF = persistent atrial fibrillation; RV4CSL = RV 4-chamber strain including the ventricular septum; RVFWSL = RV free-wall longitudinal strain.

  • Figure 3 Changes of RV function parameters after RFCA based on clinical recurrence in patients with AF rhythm at preprocedural echocardiography.AF = atrial fibrillation; FAC = fractional area change; RFCA = radiofrequency catheter ablation; RV = right ventricular; RV4CSL = right ventricular 4-chamber strain including the ventricular septum; RVFWSL = right ventricular free-wall longitudinal strain.

  • Figure 4 Changes of echocardiographic parameters before and after RFCA in participants without clinical recurrence.LSPeAF = long-standing persistent atrial fibrillation; PAF = paroxysmal atrial fibrillation; PeAF = persistent atrial fibrillation; RFCA = radiofrequency catheter ablation.


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