Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort.

Massimiliano Manfrin,Vedran Velagic,Matthias Unterhuber,Giacomo Mugnai,Werner Rauhe

doi:10.3390/jcm10153208

Abstract

Aims: The clinical role of the left atrial (LA) hypertension in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyze the role of LA pressure in patients with nonvalvular AF who underwent PV isolation and its implication for AF catheter ablation. Methods: Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were included in this analysis. Results: A total of 132 consecutive patients (97 males, 73%; mean age 58.0 ± 13.2 years) were included in the analysis. Eleven patients (8%) underwent radiofrequency ablation and 121 (92%) cryoballoon ablation. Higher LA pressures were found in 54 patients (40.9%). At a mean follow up of 14.3 ± 8.2 months (median 12 months), the success rate without antiarrhythmic therapy was 65.9% (87/132; considering the blanking period). Female gender and continuous mean LA pressure were significantly associated with AF recurrence and remained significant on multivariable Cox analysis (respectively, HR 1.845, 1.00–3.40, p = 0.05 and HR 1.066, 1.002–1.134, p = 0.04). We identified a LA mean pressure of >15 mmHg as ideal cutoff and constructed a model to predict AF recurrence which fitted with a concordance index (C-index) of 0.65 (95% CI 0.56–0.75), logrank score p = 0.003.

Highlights

Atrial fibrillation (AF) is the most common rhythm disturbance in western society.Pulmonary vein (PV) isolation remains the cornerstone for the treatment of symptomatic drug-refractory paroxysmal AF [1]
In this study we investigated the role of left atrium (LA) pressure in a sample of patients having undergone catheter ablation of AF in order to analyze the prevalence of LA hypertension in this population and to understand its role as a possible predictor of AF recurrence following the pulmonary vein (PV) isolation
Acute procedural success with complete PV isolation was achieved in all the procedures

Summary

Introduction

Atrial fibrillation (AF) is the most common rhythm disturbance in western society. Pulmonary vein (PV) isolation remains the cornerstone for the treatment of symptomatic drug-refractory paroxysmal AF [1]. The pathophysiology of AF is multifactorial and includes aging, hemodynamic stress, biochemical factors, and associated structural heart disease [2]. The perpetuation of AF results in progressive electrical and structural remodeling of the left atrium (LA) [3,4]. The current estimation of LA disease is commonly based on LA volume, AF duration, presence of comorbidities, associated heart diseases, cardiac imaging, and voltage mapping. A specific direct assessment of the LA pressure might provide an additional, more complex, and complete information on the LA status [5]

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Conclusion