Abstract 13597: Gender Difference in Left Atrial Electroanatomical Remodeling and Hemodynamic Association With Left Atrial Pulse Pressure in Patients With Paroxysmal Atrial Fibrillation
Background: We previously reported that female patients with atrial fibrillation (AF) have more advanced electroanatomical remodeling of left atrium (LA) and elevated left ventricular (LV) filling pressure (E/Em). Stiff LA physiology has been known to be proportional to LA pulse pressure (LApp). We hypothesized that gender difference in LA remodeling has hemodynamic linkage to stiff LA physiology in patients with AF.
Methods: We included 180 women (60±10 years, 68% paroxysmal AF [PAF]) and 180 age-AF type matched men who underwent radiofrequency catheter ablation (RFCA). LApp was measured at the beginning of procedure in sinus rhythm, and defined as LA peak pressure (v-wave) minus LA nadir pressure (y-descent). We compared LApp with clinical findings, clinical outcome, and characteristics of electroanatomical remodeling (Echo, CT, NavX) depending on gender.
Results: 1. In patients with PAF, female had greater E/Em (11.7±4.9 vs. 9.3±3.1, p<0.001) and LA volume index (CT: 79.5±22.9 vs. 65.8±16.5ml/m2, p<0.001), lower LA voltage (1.0±0.6 vs. 1.4±0.6mV, p=0.002), and more elevated LApp (15.7±6.4 vs. 13.1±6.6mmHg, p=0.04) than in male. 2. LApp has positive correlation with LA volume (CT: r=0.411, p<0.001) after adjusting age. 3. Although LApp (17.9±9.6mmHg vs. 15.0±6.5 mmHg, p=0.002) and LA volume index (CT: 91.6±22.4ml/m2 vs. 72.2±20.8ml/m2, p<0.001) were significantly greater in patients with persistent AF (PeAF) than in PAF, gender difference of LApp and LA volume index disappeared in patients with PeAF. 4. There was no gender difference in clinical outcome after AF ablation.
Conclusion: Stiff LA physiology, represented by elevated LApp, is more significant in female patients with PAF. However, this gender difference in LA remodeling disappeared in PeAF.
- © 2013 by American Heart Association, Inc.