PT  - JOURNAL ARTICLE
AU  - Ryan J Koene
AU  - Eric Buch
AU  - Young-Ji Seo
AU  - Jian-Ming Li
AU  - Mackenzi Mbai
AU  - Y Chandrashekhar
AU  - Kalyanam Shivkumar
AU  - Venkatakrishna N Tholakanahalli
TI  - Increased baseline ECG R-R dispersion predicts improvement in systolic function after atrial fibrillation ablation
AID  - 10.1136/openhrt-2018-000958
DP  - 2019 Jun 01
TA  - Open Heart
PG  - e000958
VI  - 6
IP  - 1
4099  - http://openheart.bmj.com/content/6/1/e000958.short
4100  - http://openheart.bmj.com/content/6/1/e000958.full
SO  - Open Heart2019 Jun 01; 6
AB  - Background Atrial fibrillation (AF) is associated with left ventricular (LV) systolic dysfunction which may improve after AF ablation. We hypothesised that increased ventricular irregularity, as measured by R-R dispersion on the baseline ECG, would predict improvement in the left ventricular ejection fraction (LVEF) after AF ablation.Methods Patients with LVEF <50% at two US centres (2007–2016), having both a preablation and postablation echocardiogram or cardiac MRI, were included. LVEF improvement was defined as absolute increase in LVEF by >7.5%. Multivariable logistic regression (restricted to echocardiographic/ECG variables) was performed to evaluate predictors of LVEF improvement.Results Fifty-two patients were included in this study. LVEF improved in 30 patients (58%) and was unchanged/worsened in 22 patients (42%). Those with versus without LVEF improvement had an increased baseline R-R dispersion (645±155 ms vs 537±154 ms, p=0.02, respectively). The average baseline heart rate in all patients was 93 beats per minute. After multivariable logistic regression, increased R-R dispersion (OR 1.59, 95% CI 1.00 to 2.55, p=0.03) predicted LVEF improvement.Conclusions Increased R-R dispersion on ECG was independently associated with improved systolic function after AF ablation. This broadens the existing knowledge of arrhythmia-induced cardiomyopathy, demonstrating that irregular electrical activation (as measured by increased R-R dispersion on ECG) is associated with a cardiomyopathy capable of improving after AF ablation.