Evaluation of shortness of breath after atrial fibrillation ablation—Is there a stiff left atrium?

Abstract

Ablation has emerged as the most effective therapy for atrial fibrillation (AF), with the primary goal to improve symptoms. However, there is a subset of patients who develop limiting symptoms after successful ablation despite reestablishment of sinus rhythm. There is now recognition of “stiff left atrial (LA) syndrome” related to adverse consequences of ablation itself on LA hemodynamics, as described by Gibson and others. 1 Gibson D.N. Di Biase L. Mohanty P. et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors. Heart Rhythm. 2011; 8: 1364-1371 Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar , 2 Welch T.D. Coylewright M. Powell B.D. Asirvatham S.J. Gersh B.J. Dearani J.A. Nishimura R.A. Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization. Heart Rhythm. 2013; 10: 1839-1842 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Although relatively uncommon (1.4% incidence in the Gibson series), this syndrome is important to diagnose, as it can cause severe unexplained dyspnea. In this review, we will discuss the hemodynamics of ablation-related injury and provide a diagnostic approach to persistent dyspnea after ablation.