P1027Left atrial hypertension invasively measured during pulmonary vein isolation as a predictor of atrial fibrillation recurrence

Abstract

Abstract Background The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. Purpose The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction having undergone 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 retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure >15 mm Hg. Results A total of 98 consecutive patients (71 males, 72%; mean age 60.3 ± 8.4 years) with drug resistant, non valvular AF and preserved LV ejection fraction having undergone index PV isolation procedure were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 10.7 ± 4.5 mmHg; LAH occurred in 24 (24%) patients. At a mean follow up of 14.6 ± 7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). On multivariate analysis, LAH remained the only independent predictor of definitive AF recurrence (HR 3.02, 1.36-6.72, p = 0.007). Conclusion Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences. Univariate and multivariate Cox regressi Univariate analysis Multivariate analysis Early Recurrence (during BP) HR 95%CI P value HR 95%CI P value Age (years) 1.06 1.02-1.10 0.005 1.05 1.00-1.09 0.03 LA volume (ml/m2) 1.02 1.00-1.05 0.04 1.02 1.00-1.05 0.05 LA hypertension 2.46 1.32-4.57 0.004 1.97 1.03-3.79 0.04 Recurrence after the BP HR 95%CI P value HR 95%CI P value Age (years) 1.05 1.00-1.11 0.04 1.04 0.98-1.09 0.15 LA hypertension 3.51 1.62-7.60 0.001 3.02 1.36-6.72 0.007 BP recurrence 1.83 0.84-3.99 0.13 AF atrial fibrillation. BMI: body mass index. LA: left atrium. CAD: coronary artery disease. BP: blanking period. HR: hazard ratio. CI: confidence intervals.