Abstract 12869: Uncontrolled Blood Pressure is a Predictor of Left Atrial Remodeling and Adverse Clinical Outcome After Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation
Aims: Little is known about the relation of blood pressure (BP) control with left atrial (LA) remodeling and clinical outcome after atrial fibrillation (AF) ablation.
Methods: A 101 symptomatic paroxysmal AF patients (85 males, 62.2±8.4 years) undergoing successful pulmonary vein isolation (PVI) were enrolled. Uncontrolled hypertension (HT) was defined as BP more than 140/90 mmHg calculated as mean value being recorded at least 5 different days before PVI. LA wall thickness along ablation line was measured using computed tomography before PVI. LA dimension was measured by echocardiography before and 6 months after PVI. The recurrence was determined by the documentation of AF or atrial tachycardia lasting more than 30 sec. In case of the recurrence, the second procedure was performed based on the patient’s consent. At the second procedure, if AF sustained or was induced after the pulmonary vein (PV) re-isolation or when PV was still isolated, substrate modification such as linear ablation or complex fractionated atrial electrogram ablation was performed. Patients were classified into 3 groups: group 1 (no HT, n = 48), group 2 (controlled HT, n = 34) and group 3 (uncontrolled HT, n = 19). The comparisons of the data among the groups were performed by using ANOVA and the recurrence rate of each group was analyzed by the Kaplan-Meier method.
Results: LA wall thickness in groups 2 and 3 were greater than that of group 1. However, LA wall thickness between groups 2 and 3 did not differ. During the follow up periods of 9±4 months, LA dimension of only group 3 increased after the procedure (38.2±5.6 mm to 41.3±6.2 mm, P=0.02). Thirty-one patients showed the recurrence. The recurrence rate was significantly higher in group 3 than in groups 1 and 2 (48% vs. 26% and 22%, P<0.05, respectively). Out of 31 recurrence patients, 18 underwent the second procedure. The patients in group 3 needed substrate modification more frequently than those in group 1 (100% vs. 25%, P < 0.05).
Conclusion: The existence of HT causes LA hypertrophy, regardless of whether HT is controlled or not. On the other hand, the uncontrolled BP induced the anatomical and electrical remodeling of LA, resulting in adverse long-term outcome after PVI.
Author Disclosures: M. Kamioka: None. H. Suzuki: None. Y. Matsumoto: None. M. Nodera: None. T. Kaneshiro: None. Y. Kamiyama: None. Y. Takeishi: None.
- © 2016 by American Heart Association, Inc.