Catheter Ablation Improves Ventilatory Efficiency in Atrial Fibrillation-Mediated Cardiomyopathy.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology Pub Date : 2025-02-21 DOI:10.1111/jce.16606

Nikhil Ahluwalia, David Bruce, Ashley Ashdown, Fabrizio Focacci, Hakam Abbass, Shohreh Honarbakhsh, Anthony Chow, Mehul Dhinoja, Ross J Hunter, Steffen Petersen, Guy Lloyd, Richard J Schilling

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引用次数: 0

Abstract

Background: Exercise Oscillatory Ventilation (EOV) and a steep ventilatory efficiency (VE/VCO2) slope are features of ventilatory inefficiency on cardiopulmonary exercise testing (CPET), both associated with poor prognosis in patients with heart failure (HF). The prevalence in patients with co-existent atrial fibrillation (AF) and the impact of catheter ablation (CA) is unknown.

Objectives: To characterize ventilatory inefficiency in patients with persistent AF and Left Ventricular Systolic Dysfunction (LVSD) and assess the impact of CA.

Methods: Patients with persistent AF and Left Ventricular Ejection Fraction (LVEF) < 50% undergoing first-time CA were prospectively enrolled. Echocardiography and CPET were performed at baseline and 6 months post-CA. EOV was defined using the Kremser-Corrà criteria, and VE/VCO2 slope gradient > 30 was considered abnormal.

Results: A total of 53 participants were enrolled (mean LVEF of 34 ± 9%). A total of 10 (19.2%) exhibited EOV at baseline. These patients had larger indexed left atrial (41.6 ± 13.1 mL/m² vs. 33.3 ± 9.3 mL/m², p = 0.03) and ventricular volumes [65.7 mL/m² (57.1, 89.0) vs. 46.7 mL/m² (39.8, 61.4), p = 0.03]. The partial pressure of end-tidal carbon dioxide (P_ETCO₂) at peak exercise increased (33.7 ± 6.1 mmHg to 41.2 ± 5.8 mmHg, p < 0.001) and correlated with improvement in HF symptoms (p = -0.003) and objective HF markers. A total of 25 (48.1%) had an abnormal VE/VCO2 gradient. The EOV pattern resolved in eight (80%) participants due to a reduction in EOV burden (71.1 ± 11.9% vs. 48.8 ± 14.8%, p = 0.006) and the component amplitude of minute ventilation cycles (2.6 L/min (2.5,3.2) vs 2.2 L/min (1.8,2.6), p = 0.028). Fewer patients had an abnormal VE/VCO2 gradient after CA [25 (48.1%) vs. 16 (34.0%), p = 0.004].

Conclusions: Ventilatory inefficiency is common in patients with AF and LVSD. CA improves both EOV and VE/VCO2 in AF-induced cardiomyopathy. Improvement in P_ETCO₂ is also seen and correlates with HF symptom burden.

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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.