Stiff Left Atrial Syndrome After Multiple Percutaneous Catheter Ablations

Urey, Marcus A.; Darden, Douglas; Stoller, Douglas; Drazner, Mark H.; Horn, V; Sarma, Satyam; Levine, Benjamin D.

doi:10.1161/circheartfailure.117.003885

Cited by 14 publications

(16 citation statements)

References 2 publications

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“…The risk for this ‘stiff LA atrium syndrome’ is high in patients with pre‐existing LA structural and functional abnormalities or derangements in LV diastolic filling (i.e. those with HFpEF) …”

Section: Therapeutic Challenges In Patients With a Metabolic Disordermentioning

confidence: 99%

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Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk‐to‐benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post‐ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.

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Section: Therapeutic Challenges In Patients With a Metabolic Disordermentioning

confidence: 99%

“…those with HFpEF). [252][253][254][255] underlying myopathy may be AF because AF and HFpEF have a common pathophysiological origin. Therefore, it is important to suspect the diagnosis of HFpEF in a patient with obesity or type 2 diabetes, and AF.…”

Section: Pharmacological and Procedural Rhythm Controlmentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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“…Second, the persistence of a small post-puncture ASD may have allowed for controlled left atrial decompression in the presence of a large left-to-right atrial pressure gradient. The herein observed haemodynamics are likely to worsen significantly during exercise with increased venous return to the non-compliant left atrium, 6 and controlled left-to-right atrial shunting may become important particularly on exertion. Notably, the latter principle represents the pathophysiological basis for a promising novel interventional therapy for heart failure, i.e.…”

Section: Discussionmentioning

confidence: 86%

Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one

Maeder

Nägele

Rohner³

et al. 2017

ESC Heart Failure

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We present the rare case of a patient with pulmonary hypertension in the context of the stiff left atrial syndrome after extensive catheter ablation, a unique constellation characterized by high pulmonary artery and pulmonary artery wedge pressures due to left atrial dysfunction but normal left ventricular end‐diastolic pressure, normal mitral valve, and absence pulmonary vein stenosis. This patient was surprisingly oligosymptomatic, however, which may have been due to a persistent post‐puncture atrial septal defect, which may have allowed for controlled left atrial decompression, which is in line with the novel concept of the catheter‐based creation of an intracardiac shunt as a treatment for heart failure.

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“…Although prominent LA V waves were traditionally attributed to MR, this waveform pattern is now appreciated as a manifestation of the “Stiff LA Syndrome,” in which a severely non‐compliant LA manifests prominent V waves despite the absence of MR, often resulting in left heart failure and resultant pulmonary hypertension . Although now seen most commonly after catheter ablation for atrial arrhythmias, this syndrome was first described as a complication after MV surgery.…”

Section: The V Wave Has Predictive Power But It's Not Only About Regmentioning

confidence: 99%

“…Further, under conditions of elevated mean pressure in general, and MR in particular, the LA is decompressed into the pulmonary venous circulation, whose capacitance to dampen the refluxing tide of V waves may also influence waveform characteristics. Impaired LA compliance is seen in three pathophysiologic circumstances: (1) acute MR, in which the LA is unaccomodating; (2) Although prominent LA V waves were traditionally attributed to MR, this waveform pattern is now appreciated as a manifestation of the "Stiff LA Syndrome," in which a severely non-compliant LA manifests prominent V waves despite the absence of MR, often resulting in left heart failure and resultant pulmonary hypertension [2]. Although now seen most commonly after catheter ablation for atrial arrhythmias, this syndrome was first described as a complication after MV surgery.…”

Section: The V Wave Has Predictive Power But It's Not Only About Rmentioning

confidence: 99%

Hemodynamic guidance of mitral paravalvular leak closure: The V is the key

Goldstein

2017

Cathet Cardio Intervent

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Stiff Left Atrial Syndrome After Multiple Percutaneous Catheter Ablations

Cited by 14 publications

References 2 publications

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one

Hemodynamic guidance of mitral paravalvular leak closure: The V is the key

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