Successful radiofrequency ablation determines atrio-ventricular remodelling and improves systo-diastolic function at tissue Doppler-imaging

Background: Clinical, echocardiographic results and determinants of atrial fibrillation (AF) recurrence following AF ablation during mitral valve surgery (AFAMVS) were evaluated. Methods: Fifty-two patients undergoing radiofrequency AFAMVS between January 2003 and December 2005, underwent serial echocardiographies with tissue Doppler imaging to assess atrio-ventricular function. Recurrence of AF, hospital readmission, episodes of congestive heart failure (CHF) were recorded. Predictors for AF-recurrence were evaluated. Results: At a 29.5 +/- 8.6 months of follow-up (100% complete), 78.8% patients were in sinus rhythm (SR). Freedom from AF-recurrence was 64.6 +/- 0.76%, from hospital readmission 88.9 +/- 0.47%, from CHF 91.6 +/- 0.63%. SR-patients demonstrated better freedom from hospital readmission (97.4 vs 60.6%; p = 0.0003) and from CHF (100 vs 72.7%; p = 0.008) during follow-up. At follow-up SR-patients demonstrated left atrial (preoperative 5.8 +/- 0.8 cm vs follow-up 5.1 +/- 0.9; p = 0.013) and ventricular reverse remodelling (preoperative LVDd 5.7 +/- 1.1 cm vs follow-up 5.2 +/- 1.1; p = 0.048 - preoperative LVDs 4.0 +/- 1.4 vs follow-up 3.6 +/- 1.1; p = 0.036). E/A ratio was normal in 73.1% (92.7% of SR-patients). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) of SR-patients, compared with AF-patients (Sm 9.40 +/- 1.74 vs 7.72 +/- 1.5, p = 0.0001; Em: 10.45 +/- 1.98 vs 7.68 +/- 0.72, p = 0.001; E/Em: 0.07 +/- 0.02 vs 0.10 +/- 0.04, p = 0.0001). Large preoperative atrial. diameter (OR = 5.81; p = 0.002), preoperative NYHA-IV (OR = 3.55; p = 0.001), high diuretics at discharge (OR = 1.27; p = 0.03), tricuspid insufficiency at follow-up (OR = 2.31; p = 0.02) were independent predictors of AF-recurrence. Conclusions: Radiofrequency AFAMVS achieves 78.8% of SR recovery. Maintenance of SR improves clinic, haemodynamic and echocardiographic endpoints. Pre- and postoperative cardiac failure is the main determinant of AF-recurrence. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.