Abstract 2340: Atrial Mechanical Function Using Left Atrial Pressure Waveform Analysis in Persistent and Paroxysmal Atrial Fibrillation Patients
Background: Atrial fibrillation (AF) adversely impacts left atrial (LA) mechanical function, which may reflect the underlying disease process or atrial remodeling. LA pressure measurements at the time of ablation may give insight into LA mechanical function in AF patients. Objective: We sought to examine LA mechanical function in paroxysmal and persistent AF patients and the predictors of impaired LA function.
Methods: Consecutive AF patients without other structural heart disease who underwent catheter ablation procedure from December 2006 to December 2008 were retrospectively analyzed. Seven patients who underwent left-sided atrioventricular accessory pathway ablations via a transseptal approach were enrolled as controls. LA pressure waveform (A and V wave, X and Y descent) was measured manually.
Results: A total of 52 consecutive AF patients with clear LA pressure waveform were enrolled, divided into paroxysmal (n=32) and persistent (n= 20) AF group. There were no significant differences in the X and Y descent, as well as V wave pressure between paroxysmal AF and control group patients. However, A wave pressure (13.72±4.52 vs 9.31±2.73 mmHg, P=0.02) was significantly higher in paroxysmal AF than control group, possibly reflecting impaired left atrial compliance. The V wave (24.28±7.98 vs 14.37±6.41 mmHg, P<0.001) and Y descent (10.68±6.34 vs 6.16±4.90 mmHg, P=0.007) pressure were significantly higher in persistent than paroxysmal AF group. Persistent AF (65% vs 12%, P<0.001) was predictor of high V wave pressure (≥18mmHg) in AF patients, similar result after adjusted for age and sex.
Conclusion: Paroxysmal AF patients have elevated A wave pressure, possibly reflecting impaired left atrial compliance. Persistent AF patients, however, have markedly elevated LA pressures, suggesting alterations in LA function. LA pressure measurement during ablation procedures may lead to significant insights into the changes in hemodynamic function in AF patients.