Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Abstract

Aims: The clinical role of the left atrial (LA) hypertension in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyze the role of LA pressure in patients with nonvalvular AF who underwent PV isolation and its implication for AF catheter ablation. Methods: Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were included in this analysis. Results: A total of 132 consecutive patients (97 males, 73%; mean age 58.0 ± 13.2 years) were included in the analysis. Eleven patients (8%) underwent radiofrequency ablation and 121 (92%) cryoballoon ablation. Higher LA pressures were found in 54 patients (40.9%). At a mean follow up of 14.3 ± 8.2 months (median 12 months), the success rate without antiarrhythmic therapy was 65.9% (87/132; considering the blanking period). Female gender and continuous mean LA pressure were significantly associated with AF recurrence and remained significant on multivariable Cox analysis (respectively, HR 1.845, 1.00–3.40, p = 0.05 and HR 1.066, 1.002–1.134, p = 0.04). We identified a LA mean pressure of >15 mmHg as ideal cutoff and constructed a model to predict AF recurrence which fitted with a concordance index (C-index) of 0.65 (95% CI 0.56–0.75), logrank score p = 0.003.

Prevalence, Associated Factors, and Echocardiographic Estimation of Left Atrial Hypertension in Patients With Atrial Fibrillation

“…Manfrin et al demonstrated that higher LA pressure was associated with an increased risk of AF recurrence after catheter ablation and identified a mean LA pressure of >15 mm Hg as the optimal cut‐off value. 12 Evranos et al showed that LA pressure >14 mm Hg carried a significant risk for AF recurrence after cryoablation. 10 In addition, Gilge et al reported an association between elevated LA pressure and heart failure occurrence after catheter ablation.…”

“…Noninvasive assessment of LA hypertension by speckle‐tracking echocardiography in patients with AF may have the potential to provide valuable information for the selection of optimal candidates for catheter ablation and periprocedural management, because LA hypertension carries a significant risk for AF recurrence. 10 , 12 Furthermore, central obesity and inflammation could be therapeutic targets of LA hypertension and possibly subsequent AF recurrence. Therapeutic intervention for central obesity might be able to decrease LA pressure through improvement of metabolic disorders and neurohumoral responses (ie, renin–angiotensin–aldosterone system and sympathetic nervous system).…”

“…LA hypertension was defined as mean LA pressure >15 mm Hg according to previous studies. 12 , 19 , 20 …”

“…Furthermore, exploring the determinants of LA hypertension may enhance our therapeutic strategies, including appropriate selection of patients for catheter ablation and optimal management before and after ablation treatment, because LA hypertension is associated with AF recurrence and subsequent heart failure development after catheter ablation. 10 , 11 , 12 Therefore, the aim of this study was to investigate the prevalence and associated factors of LA hypertension in patients with AF who underwent a first catheter ablation.…”

The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study

“…Our results do apply to the subgroup of patients with out-of-the-box settings with fixed AV and VV delays; also, our results apply to a population of patients treated in the period 2013-2018 and it is possible that response to CRT in contemporary practice may be better thanks to the progressive use of quadripolar leads and AV optimization algorithms. We analyzed the occurrence of AF > 7 days as a function of PR interval, even if many factors may actually condition AF onset in patients with LV dysfunction and AF [2,27,[31][32][33][34][35]. Additionally, given the observational nature of the study, granular descriptions of specific echocardiographic measurements, such as grade and type of valvular heart disease, were missing.…”