CLINICAL STUDIES
Resolution of cardiomyopathy after ablation of atrial flutter
Jose A. Luchsinger, MDa and
Jonathan S. Steinberg, MD, FACCa
a Arrhythmia Service, Division of Cardiology, St. Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
Manuscript received April 4, 1997;
revised manuscript received March 16, 1998,
accepted March 20, 1998.
Address for correspondence: Dr. Jonathan S. Steinberg, Division of Cardiology, St. Luke’s–Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025
jss7{at}columbia.edu
Objectives. We sought to serially assess left ventricular (LV) function before and after catheter ablation of atrial flutter (AFl).
Background. The relation of tachycardia-induced cardiomyopathy to AFl and its response to direct catheter ablation are unknown.
Methods. LV function was assessed in a series of 59 consecutive patients with successful radiofrequency ablation (RFA) of AFl before and after the procedure. Eleven patients had dilated cardiomyopathy (LV ejection fraction [LVEF] <50%) and congestive heart failure (CHF) symptoms and are the subject of this report. LV function was assessed by LVEF on two-dimensional echocardiography and functional status by New York Heart Association (NYHA) CHF classification.
Results. Patients were 59 ± 8 years old, and were all male. Five patients had a preablation diagnosis of idiopathic cardiomyopathy. The preablation LVEF was 30.9 ± 11.0% and improved to 41.3 ± 16% (p = 0.005) when measured 7 months after successful ablation. NYHA CHF class improved from 2.6 ± 0.5 to 1.6 ± 0.9 (p = 0.002). Six (55%) of 11 patients had normalization of the LVEF, with complete resolution of CHF symptoms. A lower preablation LVEF and functional class predicted nonresolution of dilated cardiomyopathy (p = 0.002 and 0.001, respectively).
Conclusions. Restoration of normal sinus rhythm by RFA in patients with chronic AFl and cardiomyopathy substantially improved LV function. Resolution of dilated cardiomyopathy occurred in the majority of patients. Tachycardia-induced cardiomyopathy may be a more common mechanism of LV dysfunction in patients with AFl than expected, and aggressive treatment of this arrhythmia should be considered.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | AFl | = atrial flutter | | AV | = atrioventricular | | CHF | = congestive heart failure | | ECG | = electrocardiogram, electrocardiographic | | LV | = left ventricular | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | NSR | = normal sinus rhythm | | RFA | = radiofrequency ablation |
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