Skip to main content
SpringerLink
Log in

Effects of radiofrequency catheter ablation on left ventricular structure and function in patients with atrial fibrillation: a meta-analysis

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

Radiofrequency catheter ablation (RFCA) is an effective therapy for atrial fibrillation (AF). This study was designed to investigate the effects of RFCA on left ventricular (LV) structure and function in AF patients.

Methods and Results

A systematic literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed to identify trials involving changes of LV structure and function in AF patients undergoing RFCA. Effect size was expressed as weighted mean difference (WMD) with 95 % confidence interval (CI). LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were estimated. A total of 21 trials including 1,135 participants were qualified for this meta-analysis. Compared to the baseline values, there were significant decreases in LVEDV (WMD, −6.39 ml; 95 %CI, −12.46 to −0.33) and LVESV (WMD, −6.39 ml; 95 %CI, −11.35 to −1.42) and a significant improvement in LVEF (WMD, 6.23 %; 95 %CI, 3.70 to 8.75), but no significant changes were observed in LVEDD (WMD, −0.64 mm; 95 %CI, −2.40 to 1.13) and LVESD (WMD, −0.38 mm; 95 %CI, −1.32 to 0.56) after RFCA. Subgroup analysis demonstrated that patients with low LVEF (WMD, 11.90 %; 95 %CI, 9.16 to 14.64) gained more benefits than those with normal LVEF (WMD, 1.56 %; 95 %CI, 0.38 to 2.74). Besides, patients with chronic AF (WMD, 10.96 %; 95 %CI, 4.92 to 17.01) improved more than those with paroxysmal AF (WMD, 1.93 %; 95 %CI, −0.27 to 4.12).

Conclusions

RFCA in AF patients could reverse LV structural remodeling and improve LV systolic function, especially in patients with low LVEF and chronic AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Heeringa, J., van der Kuip, D. A., Hofman, A., Kors, J. A., van Herpen, G., Stricker, B. H., et al. (2006). Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. European Heart Journal, 27(8), 949–953.

    Article  PubMed  Google Scholar 

  2. Kannel, W. B., Abbott, R. D., Savage, D. D., & McNamara, P. M. (1982). Epidemiologic features of chronic atrial fibrillation: the Framingham study. New England Journal of Medicine, 306(17), 1018–1022.

    Article  CAS  PubMed  Google Scholar 

  3. Mont, L., Bisbal, F., Hernández-Madrid, A., Pérez-Castellano, N., Viñolas, X., Arenal A., et al. (2014). Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). European Heart Journal, 35(8), 501–507.

  4. Pozzoli, M., Cioffi, G., Traversi, E., Pinna, G. D., Cobelli, F., & Tavazzi, L. (1998). Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. Journal of the American College of Cardiology, 32(1), 197–204.

    Article  CAS  PubMed  Google Scholar 

  5. Cha, Y. M., Wokhlu, A., Asirvatham, S. J., Shen, W. K., Friedman, P. A., Munger, T. M., et al. (2011). Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function. Circulation. Arrhythmia and Electrophysiology, 4(5), 724–732.

    Article  PubMed  Google Scholar 

  6. Ravens, U., Davia, K., Davies, C. H., O'Gara, P., Drake-Holland, A. J., Hynd, J. W., et al. (1996). Tachycardia-induced failure alters contractile properties of canine ventricular myocytes. Cardiovascular Research, 32(3), 613–621.

    Article  CAS  PubMed  Google Scholar 

  7. Elliott, P., Andersson, B., Arbustini, E., Bilinska, Z., Cecchi, F., Charron, P., et al. (2008). Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal, 29(2), 270–276.

    Article  PubMed  Google Scholar 

  8. Dagres, N., Varounis, C., Gaspar, T., Piorkowski, C., Eitel, C., Iliodromitis, E. K., et al. (2011). Catheter ablation for atrial fibrillation in patients with left ventricular systolic dysfunction. A systematic review and meta-analysis. Journal of Cardiac Failure, 17(11), 964–970.

    Article  PubMed  Google Scholar 

  9. Wilton, S. B., Fundytus, A., Ghali, W. A., Veenhuyzen, G. D., Quinn, F. R., Mitchell, L. B., et al. (2010). Meta-analysis of the effectiveness and safety of catheter ablation of atrial fibrillation in patients with versus without left ventricular systolic dysfunction. American Journal of Cardiology, 106(9), 1284–1291.

    Article  PubMed  Google Scholar 

  10. Kucukdurmaz, Z., Kato, R., Erdem, A., Golcuk, E., Tobiume, T., Nagase, T., et al. (2013). Catheter ablation for atrial fibrillation results in greater improvement in cardiac function in patients with low versus normal left ventricular ejection fraction. Journal of Interventional Cardiac Electrophysiology, 37(2), 179–187.

    Article  PubMed  Google Scholar 

  11. Kosiuk, J., Buchta, P., Gaspar, T., Arya, A., Piorkowski, C., Rolf, S., et al. (2013). Prevalence and predictors of worsened left ventricular diastolic dysfunction after catheter ablation of atrial fibrillation. International Journal of Cardiology, 168(4), 3613–3615.

    Article  PubMed  Google Scholar 

  12. Anselmino, M., Grossi, S., Scaglione, M., Castagno, D., Bianchi, F., Senatore, G., et al. (2013). Long-term results of transcatheter atrial fibrillation ablation in patients with impaired left ventricular systolic function. Journal of Cardiovascular Electrophysiology, 24(1), 24–32.

    Article  PubMed  Google Scholar 

  13. Teh, A. W., Kistler, P. M., Lee, G., Medi, C., Heck, P. M., Spence, S. J., et al. (2012). Long-term effects of catheter ablation for lone atrial fibrillation: progressive atrial electroanatomic substrate remodeling despite successful ablation. Heart Rhythm, 9(4), 473–480.

    Article  PubMed  Google Scholar 

  14. Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Suenari, K., Li, C. H., et al. (2012). A prospective, randomized comparison of modified pulmonary vein isolation versus conventional pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 23(11), 1155–1162.

    Article  PubMed  Google Scholar 

  15. De Potter, T., Berruezo, A., Mont, L., Matiello, M., Tamborero, D., Santibañez, C., et al. (2010). Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation. Europace, 12(1), 24–29.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Choi, A. D., Hematpour, K., Kukin, M., Mittal, S., & Steinberg, J. S. (2010). Ablation vs medical therapy in the setting of symptomatic atrial fibrillation and left ventricular dysfunction. Congestive Heart Failure, 16(1), 10–14.

    Article  PubMed  Google Scholar 

  17. Tops, L. F., Den Uijl, D. W., Delgado, V., Marsan, N. A., Zeppenfeld, K., Holman, E., et al. (2009). Long-term improvement in left ventricular strain after successful catheter ablation for atrial fibrillation in patients with preserved left ventricular systolic function. Circulation. Arrhythmia and Electrophysiology, 2(3), 249–257.

    Article  PubMed  Google Scholar 

  18. Steinhoff, J. P., & Sheahan, R. G. (2005). Tachycardia-induced cardiomyopathy: atrial fibrillation and congestive heart failure. American Journal of the Medical Sciences, 329(1), 25–28.

    Article  PubMed  Google Scholar 

  19. Reant, P., Lafitte, S., Bougteb, H., Sacher, F., Mignot, A., Douard, H., et al. (2009). Effect of catheter ablation for isolated paroxysmal atrial fibrillation on longitudinal and circumferential left ventricular systolic function. American Journal of Cardiology, 103(2), 232–237.

    Article  PubMed  Google Scholar 

  20. Nori, D., Raff, G., Gupta, V., Gentry, R., Boura, J., & Haines, D. E. (2009). Effect of catheter ablation for isolated paroxysmal atrial fibrillation on longitudinal and circumferential left ventricular systolic function. Journal of Interventional Cardiac Electrophysiology, 26(2), 109–117.

    Article  PubMed  Google Scholar 

  21. Wylie, J. V., Jr., Peters, D. C., Essebag, V., Manning, W. J., Josephson, M. E., & Hauser, T. H. (2008). Left atrial function and scar after catheter ablation of atrial fibrillation. Heart Rhythm, 5(5), 656–662.

    Article  PubMed  Google Scholar 

  22. Marsan, N. A., Tops, L. F., Holman, E. R., Van de Veire, N. R., Zeppenfeld, K., Boersma, E., et al. (2008). Comparison of left atrial volumes and function by real-time three-dimensional echocardiography in patients having catheter ablation for atrial fibrillation with persistence of sinus rhythm versus recurrent atrial fibrillation three months later. American Journal of Cardiology, 102(7), 847–853.

    Article  PubMed  Google Scholar 

  23. Gentlesk, P. J., Sauer, W. H., Gerstenfeld, E. P., Lin, D., Dixit, S., Zado, E., et al. (2007). Reversal of left ventricular dysfunction following ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(1), 9–14.

    Article  PubMed  Google Scholar 

  24. Reant, P., Lafitte, S., Jaïs, P., Serri, K., Weerasooriya, R., Hocini, M., et al. (2005). Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation, 112(19), 2896–2903.

    PubMed  Google Scholar 

  25. Chen, M. S., Marrouche, N. F., Khaykin, Y., Gillinov, A. M., Wazni, O., Martin, D. O., 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(6), 1004–1009.

    Article  PubMed  Google Scholar 

  26. Ling LH, Taylor AJ, Ellims AH, Iles LM, McLellan AJ, Lee G, Kumar S, Lee G, et al. (2013). Sinus rhythm restores ventricular function in patients with cardiomyopathy and no late gadolinium enhancement on cardiac magnetic resonance imaging who undergo catheter ablation for atrial fibrillation. Heart Rhythm, 10(9), 1334–1339.

  27. Efremidis, M., Sideris, A., Xydonas, S., Letsas, K. P., Alexanian, I. P., Manolatos, D., et al. (2008). Ablation of atrial fibrillation in patients with heart failure: reversal of atrial and ventricular remodelling. Hellenic Journal of Cardiology, 49(1), 19–25.

    PubMed  Google Scholar 

  28. Lutomsky, B. A., Rostock, T., Koops, A., Steven, D., Müllerleile, K., Servatius, H., et al. (2008). Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging. Europace, 10(5), 593–599.

    Article  PubMed  Google Scholar 

  29. Khan, M. N., Jaïs, P., Cummings, J., Di Biase, L., Sanders, P., Martin, D. O., et al. (2008). PABA-CHF Investigators: pulmonary-vein isolation for atrial fibrillation in patients with heart failure. New England Journal of Medicine, 359(17), 1778–1785.

    Article  CAS  PubMed  Google Scholar 

  30. Choi, J. I., Park, S. M., Park, J. S., Hong, S. J., Pak, H. N., do Lim, S., et al. (2008). Changes in left atrial structure and function after catheter ablation and electrical cardioversion for atrial fibrillation. Circulation Journal, 72(12), 2051–2057.

    Article  PubMed  Google Scholar 

  31. Tondo, C., Mantica, M., Russo, G., Avella, A., De Luca, L., Pappalardo, A., Fagundes, R. L., et al. (2006). Pulmonary vein vestibule ablation for the control of atrial fibrillation in patients with impaired left ventricular function. Pacing and Clinical Electrophysiology, 29(9), 962–970.

    Article  PubMed  Google Scholar 

  32. Shinbane, J. S., Wood, M. A., Jensen, D. N., Ellenbogen, K. A., Fitzpatrick, A. P., & Scheinman, M. M. (1997). Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. Journal of the American College of Cardiology, 29(4), 709–715.

    Article  CAS  PubMed  Google Scholar 

  33. Spinale, F. G., Holzgrefe, H. H., Mukherjee, R., Arthur, S. R., Child, M. J., Powell, J. R., et al. (1995). LV and myocyte structure and function after early recovery from tachycardia-induced cardiomyopathy. American Journal of Physiology, 268(2 Pt 2), H836–H847.

    CAS  PubMed  Google Scholar 

  34. Fiala, M., Wichterle, D., Bulková, V., Sknouril, L., Nevralová, R., Toman, O., et al. (2014). A prospective evaluation of haemodynamics, functional status, and quality of life after radiofrequency catheter ablation of long-standing persistent atrial fibrillation. Europace Europace, 16(1), 15–25.

    Article  Google Scholar 

  35. Schotten, U., Greiser, M., Benke, D., Buerkel, K., Ehrenteidt, B., Stellbrink, C., et al. (2002). Atrial fibrillation-induced atrial contractile dysfunction: a tachycardiomyopathy of a different sort. Cardiovascular Research, 53(1), 192–201.

    Article  CAS  PubMed  Google Scholar 

  36. Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan, D. J., et al. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials, 17(1), 1–12.

    Article  CAS  PubMed  Google Scholar 

  37. Higgins JPT., Green S. Assessing risk of bias in included studies. In: Cochrane handbook for systematic reviews of interventions, version 5.1.0, updated March 2011. www.cochrane-handbook.org. Accessed 1 March 2012.

Download references

Acknowledgments

The authors thank the staff at Jinan Quanfang Science & Technology Co., Ltd., for their bibliographic retrieval service.

Sources of fundings

This work was supported by the National Natural Science Foundation of China (81270237), the specialized research fund for the doctoral program of higher education (20110131110063), and the Foundation of Shandong Province (2011WSB04013).

Author information

Authors and Affiliations

  1. Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, 250014, Jinan, China

    Pengju Zhu, Yong Zhang, Peiqing Jiang, Zhongsu Wang, Jiangrong Wang & Yinglong Hou

  2. Department of Clinical Medicine, Medicine College, Shandong University, Jinan, China

    Pengju Zhu & Peiqing Jiang

  3. Department of Science and Education, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China

    Xiangcui Yin

Authors
  1. Pengju Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peiqing Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhongsu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jiangrong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiangcui Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yinglong Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yinglong Hou.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, P., Zhang, Y., Jiang, P. et al. Effects of radiofrequency catheter ablation on left ventricular structure and function in patients with atrial fibrillation: a meta-analysis. J Interv Card Electrophysiol 40, 137–145 (2014). https://doi.org/10.1007/s10840-014-9903-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-014-9903-1

Keywords

Search

Navigation