Abstract
Catheter ablation is the most effective rhythm control method for patients with atrial fibrillation (AF); however, it inevitably causes atrial tissue damage. We previously reported that AF catheter ablation (AFCA) increases left atrial (LA) pressure without changes in symptom scores. We hypothesized that extensive LA ablation increased the risk of stiff LA physiology. We included 1,720 patients (69.1% male, 60.0 [53.0–68.0] years old, 66.2% with paroxysmal AF) who underwent de novo AFCA and echocardiography before and 1-year after the procedure. Stiff LA physiology was defined, when the amount of the estimated pulmonary arterial pressure increase between the pre-procedural and the 1-year post-procedural follow-up echocardiography was >10 mmHg and when right ventricular systolic pressure (RVSP) was >35 mmHg at 1-year follow-up echocardiography. The failed rhythm control within 1 year was defined as recurrent AF despite using anti-arrhythmic drugs or cardioversion within a year of AFCA. We explored the incidence and risk factors for stiff LA physiology and the rhythm outcome of AFCA. Among the 1,720 patients, 64 (3.7%) had stiff LA physiology 1 year after AFCA. Stiff LA physiology was independently associated with diabetes (odds ratio [OR], 2.36 [95% CI, 1.14–4.87], p = 0.020), the ratio of the peak mitral flow velocity of the early rapid filling to the early diastolic velocity of the mitral annulus (E/Em; OR, 1.04 [95% CI, 1.00–1.10], p = 0.049), LA pulse pressure (Model 2: OR, 1.05 [95% CI, 1.00–1.11], p = 0.049), low LA voltage (OR, 0.36 [95% CI, 0.18–0.74], p = 0.005), empirical extra-pulmonary vein (PV) LA ablation (OR, 2.60 [95% CI, 1.17–5.74], p = 0.018), and radiofrequency (RF) ablation duration (Model 2: OR, 1.02 [95% CI, 1.01–1.03], p = 0.003). Although the incidence of post-AFCA stiff LA physiology was 3.7% and most of the cases were subclinical, the empirical extra-PV ablation was associated with this undesirable condition. In addition, patients who had low mean LA voltage before AFCA could be susceptible to stiff LA physiology.
Highlights
Catheter ablation is the most effective rhythm control method for patients with atrial fibrillation (AF), and various clinical benefits of catheter ablation have been reported, including a reduction in the mortality rate in patients with heart failure (Marrouche et al, 2018)
Park et al reported an elevated left atrial (LA) pressure and stiffness at the time of repeat ablation as compared to de novo procedures (Park et al, 2019). They found that the level of the increase in LA pressure was more significant in patients who underwent an empirical extra-pulmonary vein (PV) LA ablation than in those who underwent a circumferential PV isolation (CPVI) alone
The purpose of this study was to identify the incidence and clinical predictors associated with the development of stiff LA physiology after AF catheter ablation (AFCA) and to evaluate whether it was related to the empirical extra-PV LA ablation
Summary
Catheter ablation is the most effective rhythm control method for patients with atrial fibrillation (AF), and various clinical benefits of catheter ablation have been reported, including a reduction in the mortality rate in patients with heart failure (Marrouche et al, 2018). Park et al reported an elevated left atrial (LA) pressure and stiffness at the time of repeat ablation as compared to de novo procedures (Park et al, 2019). They found that the level of the increase in LA pressure was more significant in patients who underwent an empirical extra-PV LA ablation than in those who underwent a circumferential PV isolation (CPVI) alone. We applied the previously reported echocardiographic definition of stiff LA physiology (Witt et al, 2014)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
