Left atrial lesion formation and volume overload by open irrigation ablation technology during pulmonary vein antrum isolation: acute effects on cardiac hemodynamics

Abstract

Our goal was to evaluate acute effects of left atrial lesion formation and volume overload on hemodynamics during pulmonary vein antrum isolation (PVAI) as it might be a potential cause of acute pulmonary edema. In consecutive patients presenting for PVAI, open irrigation ablation was performed (50 W, 48°C, 15 s lesion duration, saline flow rate 30 mL/min). Blood samples were drawn from the left atrium and the pulmonary artery immediately before and 30 min after PVAI. The cardiac output (CO) and stroke volume (SV) were calculated by the method of Fick. We included 61 (27 female, 61 ± 11 years) patients suffering from paroxysmal (px; 33) or persistent (per; 28) atrial fibrillation (AF) in this study. A total of 2,917 ± 242 mL of volume was infused (2,651 ± 223 mL pxAF vs. 3,184 ± 255 mL perAF, (p < 0.01)). Total ablation time was 60 ± 7 min (52 ± 7 min in pxAF vs. 69 ± 8 min in perAF; (p < 0.001)). CO increased from 5.2 ± 1.3 to 6.2 ± 1.5 L/min (p < 0.001) during PVAI (5.7 ± 1.3 to 6.5 ± 1.7 L/min in pxAF; (p < 0.002) and 4.8 ± 1.1 to 5.9 ± 1.2 L/min in perAF; (p < 0.001)). SV increased from 74 ± 24 to 83 ± 21 mL (p < 0.005) during PVAI, and subgroups showed an increase of 82 ± 23 to 88 ± 22 mL in pxAF (p < 0.009) and 62 ± 21 to 76 ± 16 mL in perAF (p < 0.009). From our preliminary experience, left atrial scarring and volume overload during PVAI do not seem to impact negatively hemodynamics. On the contrary, an improvement in cardiac output was documented acutely independent of type of AF.