Abstract 15056: High Left Atrial Pressure is an Independent Predictor for Clinical Recurrence of Atrial Fibrillation after Catheter Ablation, Associated with Left Ventricular Diastolic Dysfunction and Left Atrial Remodeling
Background: Although it has been known that left ventricular (LV) function may affect to left atrial pressure (LAP) or LA remodeling, their relationships and clinical significance are not clearly elucidated. The purpose of this study was to compare the clinical, image, and electrophysiological parameters in terms of LAP in patients with atrial fibrillation (AF) who underwent radiofrequency catheter ablation (RFCA).
Methods: We measured LAP during sinus rhythm (SR) and AF in 454 patients with non-valvularAF (76.7% male, 58±11years, 65.7% paroximal AF) who underwent RFCA. Pressures of LA v-wave (LApeak), LA x-wave (LAnadir), mean LAP (LAmean), and LA pulse pressure (LAP-P) were compared with cardiac CT, Echocardiogram, NavX voltage maps, and clinical outcome.
Results: 1 . The group with LApeak(SR)≥22mmHg(n=184) had larger LA dimension (42.61±6.66 vs 40.07±5.77mm, p<0.001), LA volume index (37.11±14.00 vs 33.00±10.56ml/m2, p=0.003),higher E/E’ (11.31±6.59 vs 9.91±5.55, p<0.001), reduced S’ (6.14±1.75 vs 6.78±1.63cm/sec , p<0.001) and decreased mean LA voltage (1.06±0.61 vs 1.37±0.66mv, p<0.001) than those with LApeak(SR)<22mmHg (n=270). 2. The group (n=170) with LApeak(AF)≥22mmHg had larger LA dimension (42.68±6.50 vs 41.04±5.81mm, p=0.025), increased LV mass index (LVMI: 101.41±23.33 vs 93.11±20.11g/m2, p=0.017) and relative wall thickness (RWT: 0.39±0.06 vs 0.37±0.05, p=0.002) than those (n=197) with LApeak(AF)<22mmHg. 3. In multivariate regression analyses, high E/E’ (OR 0.337, 95%CI 0.029∼0.646, p=0.032), greater LA dimension (OR 0.411, 95%CI 0.072∼0.751, p=0.018) and reduced mean LA voltage (OR -5.565, 95%CI -7.672∼ -3.458, p<0.001) were independent predictors for high LApeak(SR). 4. During 7.8±4.3months follow-up, LAP-P (HR 1.053, 95% CI 1.009-1.099, p=0.018) and LApeak(SR) (HR 1.043, 95% CI 1.002-1.086, p=0.04) were independent predictors for clinical recurrence after RFCA adjusting age, sex, LA dimension, mean LA voltage.
Conclusions: Elevated LAP was closely associated with high LV mass, LV diastolic dysfunction, and electroanatomical remodeling of LA in patients with AF. High LApeak (SR) and LAP-P were independent predictors for clinical recurrence after catheter ablation of AF
- © 2012 by American Heart Association, Inc.