PMC10395767_01
Timeline of key events and evolution of cardiac function, from initiation of R-CHOP therapy to 15 months post-ablation.. *LVEF was determined by CMR. All other LVEF values and GLS scores were obtained using transthoracic echocardiography. AF = atrial fibrillation. AFL = atrial flutter. CMR = cardiac magnetic resonance. GLS = global longitudinal strain. LVEF = left ventricular ejection fraction. R-CHOP = rituximab-cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone.
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Depressed LVEF (45%) was first detected five months after completion of the R-CHOP regimen during an unrelated hospital stay; LVEF previously was normal at the start of chemotherapy (Figure 1).
CMR images demonstrated an absence of LV fibrosis.. CMR = cardiac magnetic resonance. LV = left ventricular.
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ECG-gated fast imaging employing steady-state acquisition (FIESTA) CMR was performed one-month post-ablation and revealed an LVEF of 44% and an absence of LV fibrosis by LGE, thereby excluding anthracycline-related cardiac damage (Figure 2).
Changes in heart rate (A) and indirect markers of cardiac function (B-D) following catheter ablation for AF/AFL. (A) Pre-ablation ECGs demonstrated AF with controlled ventricular rates; post-ablation ECGs revealed NSR with an average heart rate of 61 bpm. (B) PA diastolic pressure was elevated prior to ablation and subsequently stabilized to an average of 21 mmHg one-month post-ablation. (C) Serum creatinine was elevated pre-ablation and subsequently decreased to normal range within two months of ablation. (D) NT-proBNP was elevated pre-ablation and subsequently decreased post-ablation.. AF = atrial fibrillation. AFL = atrial flutter. ECG = electrocardiogram. NSR = normal sinus rhythm. NT-proBNP = N-terminal pro-B-type natriuretic peptide. PA = pulmonary artery.
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These markers included serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), serum creatinine, and diastolic pulmonary artery (PA) pressure as detected by an implantable CardioMEMs device (Figure 3B-D). ECGs performed at routine office visits following catheter ablation demonstrated normal sinus rhythm with an average heart rate between 60-65 bpm, approximately 30 points lower than pre-ablation ECGs (Figure 3A).