Right ventricular dysfunction in patients with symptomatic atrial fibrillation: Prevalence and functional implications.

BACKGROUND

Assessment of left ventricular (LV) function is an essential component of guideline-recommended management of atrial fibrillation (AF). However, the role and implications of right ventricular (RV) dysfunction in AF are poorly understood.

OBJECTIVE

This study aimed to determine the prevalence of RV dysfunction and evaluate its association with cardiorespiratory fitness (CRF) and symptom burden in patients with symptomatic AF.

METHODS

Consecutive adults with symptomatic paroxysmal or persistent AF and preserved LV ejection fraction scheduled for catheter ablation underwent transthoracic echocardiography, cardiopulmonary exercise testing, and AF symptom assessment. RV dysfunction was defined as tricuspid annular plane systolic excursion of ≤1.7 cm and/or tissue Doppler s' velocity of ≤9.5 cm/s. CRF was determined by peak oxygen consumption (peak oxygen uptake [VO2peak]) during cardiopulmonary exercise testing.

RESULTS

Among 241 patients (mean age 66 ± 10 years; 25% female), RV dysfunction was present in 35 patients (14.5%) despite preserved LV systolic function. Patients with RV dysfunction had lower CRF (VO2peak 17.9 ± 6.7 vs 21.1 ± 6.6 mL/kg/min; P = .01) independent of rhythm, with a greater proportion exhibiting severely reduced CRF (VO2peak <16 mL/kg/min: 43% vs 23%; P = .026). There was no association between RV dysfunction and AF symptom severity (P = .59). Structural chamber dimensions were comparable. Patients with RV dysfunction demonstrated higher E/e' (P = .006), lower left atrial reservoir strain (P < .001), and LV global longitudinal strain (P < .001).

CONCLUSION

RV dysfunction is present in a substantial proportion of patients with symptomatic AF despite preserved LV systolic function and is independently associated with reduced CRF. Reduced RV function may be considered as a therapeutic target in the treatment of symptomatic AF.