Risk of stiff left atrial syndrome following pulse-field-based ablation of atrial fibrillation in patients with pulmonary hypertension at baseline

Abstract

Abstract Introduction Studies have reported development of stiff LA syndrome, defined as pulmonary hypertension (PH) secondary to reduced LA compliance, in some patients following AF ablation. Purpose We compared the risk of worsening of baseline PH in non-paroxysmal AF (persistent and long-standing persistent AF) patients undergoing repeat procedures, either pulse-field ablation (PFA) or standard radiofrequency ablation (RFA). Methods This multicenter study included 28 non-paroxysmal AF patients with PH, undergoing PFA-based ablation procedure after >1 failed radiofrequency ablations (RFA). A cohort of 28 AF patients with PH that were scheduled for repeat RF ablation were identified. Propensity scores were computed using multivariate logistic model. Twenty-eight patients from the RFA cohort were selected by 1:1 propensity score matching with the PFA group. Right heart catheterization was performed pre- and post-procedure to assess the Pulmonary artery pressure (PAP). PH was defined as resting mean PAP of ≥20 mmHg. The follow-up PAP and change from baseline were compared between PFA and RFA groups, after controlling for baseline PAP in an ANCOVA model. Results Baseline characteristics of PFA (age 62.21 ± 9.3 yrs, male 19 (67.9%), LAD 3.7 ± 0.66 cm) and propensity-matched RF groups (age 62.39 ± 9.3 yrs, male 18 (64.3%), LAD 3.7 ± 0.74 cm) were comparable. The mean pulmonary artery pressure (PAP) assessments at baseline, follow-up and change from baseline are presented in table below. The groups had comparable baseline PAP (p= 0.157). At follow-up, RF group reported 19.81 mm Hg increase in PAP (within-group p <0.001). In PFA group, follow-up PAP showed a decreasing trend (-1.67 mm Hg, within-group p= 0.114). Compared to PFA, the change was significantly higher in RFA (p <0.0001) after controlling for baseline PAP). Conclusion In this propensity-matched population, pulse-field ablation was demonstrated to be a safer option in terms of post-ablation worsening of PAP, compared to the RF ablation in AF patients with pulmonary hypertension at baseline.