Abstract 16281: Mild “Stiff Left Atrial Syndrome” Commonly Presents as Persistent Cough Following Atrial Fibrillation Ablation
Introduction: We observed an unusual persistent, dry non-productive cough commonly occurring immediately following catheter ablation (CA) for atrial fibrillation (AF). The cough worsens with speech, does not respond to antitussive medications, and resolves spontaneously in 2-3 months. We sought to determine the etiology of this cough.
Methods: Consecutive patients (n=108) undergoing AF ablation were followed for occurrence of post-CA cough. Clinical characteristics and procedural details were examined. All patients received a proton pump inhibitor prior to and for 1 month after CA.
Results: Eleven patients (10%) presented with post-CA cough. Post-CA cough patients were non-smokers and with no history of lung disease. There was no difference in age, gender, AF type (paroxysmal vs persistent), length of procedure, procedural detail, left atrial (LA) size, left ventricular function, body mass index, diabetes, and ACE-I use among the groups. LA pressure was higher in post-CA cough patients (18 vs 14 mmHg, p= 0.03). Cough evaluation was negative including physical exam, blood work, chest radiography to rule out heart failure/infection, fluoroscopy to rule out phrenic nerve paralysis, cardiac tomography to rule out pulmonary vein stenosis, and ENT evaluation to rule out other organic causes. Cough resolved spontaneously in 2.6 ± 1 month.
Conclusion: An unusual dry cough frequently occurs post-CA for AF, is associated with speech and resolves spontaneously. This cough is related to underlying elevation in left atrial pressure. Stiff LA Syndrome is a very rare complication of CA related to underlying elevated LA pressure and manifesting as severe dyspnea and heart failure. We hypothesize that the unusual cough represents a mild form of Stiff LA Syndrome and it may respond to diuretics. It is important for clinicians to recognize this entity in order to avoid unnecessary testing.
- © 2013 by American Heart Association, Inc.