Abstract
Stiff left atrial (LA) syndrome was initially reported in post-cardiac surgery patients and known to be associated with low LA compliance. We investigated the physiological and clinical implications of LA compliance by estimating LA pulse pressure (LApp) among patients with atrial fibrillation (AF) and structurally and functionally normal heart. Among 1038 consecutive patients with LA pressure measurements before AF ablation, we included 334 patients with structurally and functionally normal heart (81.7% male, 54.1±10.6 years, 77.0% paroxysmal AF) after excluding those with hypertension, diabetes, and previous ablation or cardiac surgery. We measured LApp (peak-nadir LA pressure) at the beginning of the ablation procedure and compared the values with clinical parameters and the AF recurrence rate.AF patients with normal heart were younger and more frequently male and had paroxysmal AF, a lower body mass index, and a lower LApp compared to others (all p<0.05).Based on the median value, the low LA compliance group (LApp≥13mmHg) had a smaller LA volume index and lower LA voltage (all p<0.05) compared to the high LA compliance group. During a mean follow-up of 16.7±11.8 months, low LA compliance was independently associated with two fold-higher risk of clinical AF recurrence (HR:2.202; 95%CI:1.077–4.503; p = 0.031).Low LA compliance, as determined by an elevated LApp, was associated with a smaller LA volume index and lower LA voltage and independently associated with higher clinical recurrence after catheter ablation in AF patients with structurally and functionally normal heart.
Highlights
Stiff left atrial (LA) syndrome, was initially reported by Pilote et al in 1988, presenting as severe pulmonary hypertension 7 years after mitral valve surgery.[1]In their report, cardiac catheterization revealed a marked V wave without any mitral prosthetic valve dysfunction or PLOS ONE | DOI:10.1371/journal.pone.0143853 December 1, 2015Low Left Atrial Compliance and atrial fibrillation (AF) Ablation regurgitation
It is reported to occur more in patients with previous LA scarring and small LA dimensions. [2]Recently, we reported that high LA pressures are associated with both advanced electroanatomical remodeling of LA and independent predictors for clinical recurrence of AF after catheter ablation.[4]it is unclear whether LA compliance has some clinical implication in patients who underwent radiofrequency catheter ablation (RFCA)
We intentionally excluded patients with diabetes to rule out metabolic factors affecting LA compliance; the results were consistent when the patients with diabetes (n = 21) were included in the normal heart AF group (S1 Table).Patients in the normal heart AF group were younger and more likely to be male and to have paroxysmal AF
Summary
Stiff left atrial (LA) syndrome, was initially reported by Pilote et al in 1988, presenting as severe pulmonary hypertension 7 years after mitral valve surgery.[1]In their report, cardiac catheterization revealed a marked V wave without any mitral prosthetic valve dysfunction or PLOS ONE | DOI:10.1371/journal.pone.0143853 December 1, 2015Low Left Atrial Compliance and AF Ablation regurgitation. Stiff left atrial (LA) syndrome, was initially reported by Pilote et al in 1988, presenting as severe pulmonary hypertension 7 years after mitral valve surgery.[1]In their report, cardiac catheterization revealed a marked V wave without any mitral prosthetic valve dysfunction or PLOS ONE | DOI:10.1371/journal.pone.0143853. Stiff LA syndrome has generally been defined as pulmonary hypertension that develops long after cardiac surgery without any other cardiac cause.[1]this syndrome regained attention in patients who had undergone catheter ablation for atrial fibrillation (AF), especially after multiple ablation procedures.[2] there have been reports of more extensive ablation, resulting in better clinical outcomes in patients with persistent AF (PeAF),[3] more touches may reduce LA compliance. Pulmonary hypertension after catheter ablation is detected in 1.4% of patients without pulmonary vein (PV) stenosis. There are several different indirect ways to estimate LA compliance,[5,6] we quantified LA compliance by directly measuring the LA pulse pressure (LApp) at the beginning of the procedure and assumed minimal change in LA volume.[5,6,7]
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