Information de reference pour ce titreAccession Number: | 00009733-200701000-00003.
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Author: | GENTLESK, PHILIP J. M.D.; SAUER, WILLIAM H. M.D.; GERSTENFELD, EDWARD P. M.D.; LIN, DAVID M.D.; DIXIT, SANJAY M.D.; PA-C, ERICA ZADO; CALLANS, DAVID M.D.; MARCHLINSKI, FRANCIS E. M.D.
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Institution: | Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Title: | |
Source: | Journal of Cardiovascular Electrophysiology. 18(1):9-14, January 2007.
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Abstract: | Background: Evaluation of ventricular rate control in atrial fibrillation (AF) can be difficult, and the presence of an AF-induced ventricular cardiomyopathy due to intermittent poor rate control or other causes may be underestimated. The outcome with AF ablation in patients with a decreased left ventricular ejection fraction (LVEF) may provide insight into this important clinical issue.
Objective: To determine the effect of pulmonary vein isolation on LVEF in patients with AF and decreased LVEF (<=50%).
Methods: Ablation consisted of proximal isolation of arrhythmogenic pulmonary veins (PVs) and elimination of non-PV triggers. LVEF was determined within 24 hours after ablation and again at up to 6 months follow-up. Transtelephonic monitoring was performed routinely for 2-3 weeks prior to ablation, at 6 weeks, and 6 months post and with symptoms following ablation. AF control was defined as freedom from AF or marked (>90%) reduction in AF burden on or off previously ineffective antiarrhythmic medication.
Results: AF ablation was performed in 366 patients and 67 (18%) patients had decreased LV function with a mean LVEF of 42 +/- 9%. An average of 3.4 +/- 0.9 PVs were isolated. AF control in the depressed LVEF group compared favorably with the normal EF group (86% vs. 87% P = NS), although more redo procedures were required (1.6 +/- 0.8 vs 1.3 +/- 0.6 procedures; P <= 0.05). Only 15 of 67 patients (22%) with decreased LVEF had shown tachycardia (>100 bpm) on repeated preablation ECG recordings during AF. In the decreased LVEF group, the LVEF increased from 42 +/- 9% to 56 +/- 8% (P < 0.001) after ablation.
Conclusions: Patients with AF and decreased LVEF undergoing AF ablation have similar success to patients with normal LVEF and have improvement in LVEF after ablation. These results suggest the presence of a reversible AF-induced ventricular cardiomyopathy in many patients with AF and depressed LV function. The presence of under-recognized and reversible cardiomyopathy even when tachycardia is not persistent is important to recognize.
Copyright (C) 2007 Blackwell Publishing Ltd.
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Author Keywords: | atrial fibrillation; arrhythmia; catheter ablation; cardiomyopathy; congestive; myocardial diseases.
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Language: | English.
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Document Type: | ORIGINAL ARTICLE: Clinical.
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Journal Subset: | Clinical Medicine.
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ISSN: | 1045-3873
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NLM Journal Code: | by4, 9010756
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