Abstract 12500: Echocardiographic Novel Predictor of Successful Outcome after Atrial Fibrillation Ablation and Time-Course of the Echocardiographic Parameters after Ablation Assessed by Speckle Tracking
Background: Atrial fibrillation (AF) is associated with left atrial (LA) remodeling caused by LA pressure or volume (LAV) overload represented as elevated left ventricular filling pressure and LA enlargement. We reported that pulmonary capillary wedge pressure was accurately estimeted (ePCWP) by the combined assessment of LAV and LA function. We hypothesized that ePCWP and LAV may be useful to predict successful outcome in AF ablation.
Methods: We enrolled 73 patients with paroxysmal AF (60±9 years) who underwent pulmonary vein isolation and examined LAV, LA emptying function (EF), strain and strain rate (SR) using speckle tracking echocardiography in sinus rhythm before and at 1 day, 1 week, 1 month and 1 year after ablation. Echocardiographic parameters were compared between non-recurrence (successful) group (n=55, sinus rhythm was continued for more than 1 year) and recurrence group (n=18). The ePCWP was estimated as 10.7 - 12.4 x log LA active EF/minimum LAV.
Results: The ePCWP and maximum LAV before ablation in recurrence group were increased compared to non-recurrence group (15±2.5 vs. 12.7±3.9mmHg, 60±15 vs. 52±14ml/m2). In non-recurrence group, ePCWP and LAV continued to decrease and LA EF and SR except just after ablation continued to improve. In multivariate analysis, ePCWP before ablation was independently associated with successful ablation. Using 13 mmHg of ePCWP, the sensitivity and specificity for successful ablation were 58 and 78% (AUC= 0.69).
Conclusion: The elevated PCWP before ablation was a predictor of AF recurrence after ablation, suggesting relation between LV filling pressure and the progression of LA remodeling responsible for AF. LA active contraction was reduced just after ablation but continued to improve and LAV continued to decrease for 1 year in successful group, suggesting recovery from stunning within 1 week and continuation of reverse structural and functional remodeling for 1 year after ablation.
- © 2013 by American Heart Association, Inc.