Abstract 14300: Baseline Low Left Atrial Pressure (lap) Identify Patients Without Non-pv Triggers And With a Higher Success Rate Following Catheter Ablation for Paroxysmal Atrial Fibrillation at the Index Procedure
Introduction: Although several studies have shown that in patients (pts) with paroxysmal AF (PAF) pulmonary vein (PV) isolation alone is sufficient to achieve freedom from AF, in some pts success rate is not satisfactory.
We sought to evaluate whether baseline left atrial pressure (LAP) plays a role in the identification of pts with lower recurrence rate.
Methods: 592 consecutive pts undergoing ablation for PAF have been included in this study. In all pts baseline LAP was recorded immediately after transseptal at index procedure. In the period between 3 to 6 months post ablation, irrespective of recurrences, pts underwent a left atrial catheterization to exclude the presence of PV reconnection. In case of reconnection, pts underwent re-isolation of the PVs and a third procedure was considered to confirm permanent isolation. PV antrum and posterior wall isolation was performed in all pts. All pts underwent challenge test with isoproterenol up to 20mcg/min to disclose for non-pv triggers. Non PV triggers were mapped but not ablated at index procedure. All patients underwent extensive follow-up.
Results: After LA catheterization, PVs were confirmed isolated in all pts. After 18.7 ± 8.6 months follow up, 167 (28.2%) pts had recurrences. Pts with recurrences had higher LAP (13.5 ± 3.7 mmHg vs. 10.5 ± 3.9 mmHg, p<0.001) and higher prevalence of non pv triggers [79/167(47.3%) vs 38 /425 (8.9%) p 12mmHg had higher risk of recurrence (HR=1.6, CI= (1.2, 2.2), p=0.003) and more non-pv triggers either sustained or not sustained (OR=1.73, CI= (1.15, 2.6) p=0.009). A cut-off value of ≤ 12 mmHg mean LAP seemed to identify pts without non PV triggers and with higher success rate.
Conclusion: Baseline low LAP identifies pts with paroxysmal AF without non pv triggers where pv antrum isolation alone is sufficient to achieve freedom from AF. A cut off value of 12 mmHg is proposed. No recurrence rate differences were found between pts with sustained and non sustained non pv triggers.
- © 2013 by American Heart Association, Inc.