Abstract 13650: Stiff Left Atrial Physiology, Estimated by Left Atrial Pulse Pressure, is an Independent Predictor for Clinical Recurrence After Catheter Ablation in Patients With Lone Atrial Fibrillation
Background: Although it was reported that the stiff left atrial (LA) physiology has some prognostic value in patients with atrial fibrillation (AF), there are practical limitations to apply atrial strain in every patient referred for AF catheter ablation. The degree of stiff LA physiology is proportional to LA pulse pressure (LApp). Therefore, we evaluated the clinical significance of LApp in patients with lone AF.
Methods: We included 249 lone AF patients with normal left ventricular (LV) function (83.9% male, 54.2±11.5years, 79.1% paroxysmal AF) who underwent radiofrequency catheter ablation (RFCA). The patients with hypertension or E/Em>15 were excluded. 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 and characteristics of electroanatomical remodeling and electrocardiography.
Results: 1. Based on LApp median value 14mmHg, high LApp group (n=108) had lower mean LA voltage (NavX; 1.07±0.63 vs. 1.43±0.74mV, p=0.001) and lower amplitudes of P wave in lead II (14.6±4.9 vs. 15.9±4.8mV, p=0.038) and negative P-terminal force in V1 (5.6±3.5 vs. 6.6±3.4mV, p=0.027) than in low LApp group (n=141). 2. LApp has negative linear correlation with mean LA voltage (r=-0.245, p=0.001). 3. During 15.8±6.3 months follow-up, clinical recurrence rate of AF was 18.4%, and high LApp was independently associated with clinical recurrence (HR=3.227, 95% CI 1.217-8.558, p<0.019) in this lone AF patient group with normal LV systolic and diastolic function.
Conclusions: Stiff LA physiology in patients with lone AF accompanies the changes in ECG or LA voltage, and is an independent predictor of clinical recurrence after catheter ablation.
- © 2013 by American Heart Association, Inc.