Abstract 15909: The Post-Ablation V-Wave: An Early Marker of Stiff Left Atrial Syndrome?
Background: Stiff left atrial (LA) syndrome is becoming increasingly recognized as an important cause of post-AF ablation morbidity. Ablation may acutely negatively affect chamber compliance leading to LA hypertension and the subsequent syndrome of dyspnea and heart failure.
Objective: We hypothesized that LA ablation would negatively affect LA compliance. To assess for this, we examined LA pressures and waveforms immediately before and after ablation in two distinct populations; paroxysmal (PAF) and persistent AF (PerAF) patients.
Methods: Twenty eight patients undergoing a first ablation were included. PAF patients (n=14) underwent PVI only, whereas PerAF patients (n=14) underwent PVI +/- LA body ablation. LA pressures were directly measured immediately pre and post-ablation. All patients had baseline echocardiography to assess EF, LA size, and rule out significant mitral regurgitation. Peri-operative data collection included fluid balance, weights, and BNP levels.
Results: The mean and peak LAP increased in both groups; however, the difference between peak and mean LAP (Peak-Mean LAP) was only significant in the PerAF group (see figure). There was a trend toward higher baseline mean LAP in the PerAF group, but no significant difference in baseline peak LAP. The baseline differences between mean and peak LAP were < 10 mmHg in both groups. There were no significant differences in fluid balance or weight. There was a trend toward greatest reduction in BNP in the PerAF group ( -198 vs -36, p=0.06).
Conclusions: PerAF ablation is associated with the development of LA hypertension in the acute phase; which may be due to the direct effects of ablation on chamber compliance. Similar to acute reductions in BNP, prominent V waves may be an early marker for the Stiff LA Syndrome.
- © 2011 by American Heart Association, Inc.