Hypertension is associated with the development of atrial fibrillation (AF). The purpose of this study was to investigate the impact of hypertension on the properties of atrial substrate and the outcome of catheter ablation in patients with persistent AF.Design and Method:
One hundred and fifty patients (mean age of 62 years, 80% men) with persistent AF were enrolled. Hypertension was present in 79 patients. Extensive encircling pulmonary vein isolation plus ablation of complex fractionated atrial electrograms were performed. Bepridil or amiodalone was prescribed for three months. All patients were prospectively studied by echocardiography and 24-h ambulatory electrocardiogram at baseline and the day after ablation and at 3-, 6-month intervals.Results:
Age (65 ± 9 vs 57 ± 11year, p < 0.001), left atrial dimension before ablation (44 ± 5 vs 41 ± 5 mm, p < 0.001), intraventricular septal thickness (11 ± 2 vs 9 ± 1 mm, p < 0.001), and posterior wall thickness (11 ± 2 vs 10 ± 1 mm, p < 0.001) were significantly different between the patients with hypertension and without. Recurrence of AF after blanking period of three months was observed in 61 patients at 2 years follow up period. There were no differences in age, gender, presence of hypertension or left ventricular hypertrophy, duration of AF, CHADS2 score, CHA2DS2-VASc score, or left atrial dimension before ablation between the patients with AF recurrence and without. Left atrial dimensions decreased significantly at 3 month (43 ± 5 vs 40 ± 6 mm, p < 0.001) and at 6 month (43 ± 5 vs 40 ± 6 mm, p < 0.001) after ablation in the patients without AF recurrence. The cut off value of 2% reduction in the left atrial dimension at 6 month was the independent predictor of freedom from AF recurrence (p < 0.05).Conclusions:
Left atrial reverse remodeling prevents recurrence of AF after catheter ablation of persistent AF in hypertensive as well as non-hypertensive patients.