The Impact of Elevated Left Atrial Pressure in Sinus Rhythm After Cardioversion on Outcomes After Catheter Ablation for Atrial Fibrillation

Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

doi:10.1111/jce.12993

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…These results were not contradictory, when the above‐mentioned residual arrhythmogenic triggers/substrates were considered in those experiencing EPRs. In the patients with EPRs after the 2nd session, which might be associated with the residual triggers/substrates, a high E/E′ ratio indicative of a high left atrial pressure could predict the long‐term arrhythmia recurrences after the blanking period, as an invasively measured left atrial pressure is reported to be an independent predictor of recurrence after AF ablation . On the other hand, the elimination of the triggers/substrates by the RFCA would have prevented the AF/AT recurrences regardless of the E/E′ ratio, and thus the E/E′ ratio was not a predictor of LPRs in the entire study cohort.…”

Section: Discussionmentioning

confidence: 99%

“…In the patients with EPRs after the 2nd session, which might be associated with the residual triggers/substrates, a high E/E ratio indicative of a high left atrial pressure could predict the long-term arrhythmia recurrences after the blanking period, as an invasively measured left atrial pressure is reported to be an independent predictor of recurrence after AF ablation. 25 On the other hand, the elimination of the triggers/substrates by the RFCA would have prevented the AF/AT recurrences regardless of the E/E ratio, and thus the E/E ratio was not a predictor of LPRs in the entire study cohort. We presumed that the predominant mechanism of the blanking period phenomenon after the 2nd RFCA would have been related to the residual arrhythmogenic triggers/substrates with a lower left atrial pressure, which did not stimulate the triggers/substrates in the late period after the ablation.…”

Section: Presumed Mechanism For the Blanking Period Phenomenon After mentioning

confidence: 90%

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Blanking Period Phenomenon After a Second Atrial Fibrillation Ablation Session: The Application and Factors Related to It

Fujimoto

Hayashi

Iwasaki

et al. 2016

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Presumed Mechanism For the Blanking Period Phenomenon After mentioning

confidence: 90%

Blanking Period Phenomenon After a Second Atrial Fibrillation Ablation Session: The Application and Factors Related to It

Fujimoto

Hayashi

Iwasaki

et al. 2016

Cardiovasc electrophysiol

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“…The reduction in chamber distensibility following catheter ablation causes LA pressures to increase disproportionately as the chamber fills with pulmonary venous blood, even though sinus rhythm is restored. Post-ablation increases in LA pressures are seen in up to 40% of unselected patients 29 ; such increases presage a high rate of recurrence of AF during follow-up 30 , 31 …”

Section: Consequences Of the Ablation-related Impairment Of Left Atrimentioning

confidence: 99%

Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation

Packer

2019

European Heart Journal

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The critical role of the left atrium (LA) in cardiovascular homoeostasis is mediated by its reservoir, conduit, systolic, and neurohormonal functions. Atrial fibrillation is generally a reflection of underlying disease of the LA, especially in patients with heart failure. Disease-related LA remodelling leads to a decline in both atrial contractility and distensibility along with an impairment in the control of neurohormonal systems that regulate intravascular volume. Catheter ablation can lead to further injury to the atrial myocardium, as evidenced by post-procedural troponin release and tissue oedema. The cardiomyocyte loss leads to replacement fibrosis, which may affect up to 30–35% of the LA wall. These alterations further impair atrial force generation and neurohormonal functions; the additional loss of atrial distensibility can lead to a ‘stiff LA syndrome’, and the fibrotic response predisposes to recurrence of the atrial arrhythmia. Although it intends to restore LA systole, catheter ablation often decreases the chamber’s transport functions. This is particularly likely in patients with long-standing atrial fibrillation and pre-existing LA fibrosis, especially those with increased epicardial adipose tissue (e.g. patients with obesity, diabetes and/or heart failure with a preserved ejection fraction). Although the fibrotic LA in these individuals is an ideal substrate for the development of atrial fibrillation, it may be a suboptimal substrate for catheter ablation. Such patients are not likely to experience long-term restoration of sinus rhythm, and catheter ablation has the potential to worsen their haemodynamic and clinical status. Further studies in this vulnerable group of patients are needed.

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“…Park et al showed elevated peak LA pressure to be closely associated with electroanatomic remodeling of the left atrium and to be an independent predictor for AF recurrence after PVI 19) . In addition, Kishima et al calculated the difference between mean LA pressure during SR and mean LA pressure during AF (LAPSR-AF) and showed association between a great difference (LAPSR-AF ≥ 0 mmHg) and a poor outcome after PVI 20) .…”

Section: La Pressure and Recurrence Of Afmentioning

confidence: 99%

Association between Elevated Left Atrial Pressure and Poor Prognosis after PVI for Atrial Fibrillation

Iso

Watanabe

Okumura

et al. 2018

Nichidai Igaku Zasshi

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Left atrial (LA) stretch attributable to elevated LA pressure is known to play an important role in the perpetuation of atrial fibrillation (AF). However, the relation between LA pressure and the outcome of pulmonary vein isolation (PVI) for AF remains to be elucidated. Therefore, we investigated the relationships between post-PVI recurrence of AF, LA pressure, and pre-ablation variables. Methods and Results: The study group comprised 60 consecutive patients who were undergoing ablation for AF (46 men, 14 women; mean age, 59.5 ± 11 years; paroxysmal AF [PAF], n = 35; persistent AF [Per AF], n = 25). The patient characteristics and biomarkers of inflammation, fibrosis and heart failure measured before ablation were compared between patients in whom AF recurred after a 3-month blanking period and those in whom it did not. No significant differences were found in clinical or echocardiographic variables or biomarker concentrations between the patients with and without recurrence. However, the mean LA pressure was elevated in patients in whom AF recurred (12.2 ± 0.99 vs. 7.99 ± 0.62 mmHg, respectively, P < 0.001). Body mass index and serum atrial natriuretic peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were higher; hypertension was more prevalent, and the LA diameter and volume were greater in patients with a mean LA pressure ≥ the median value of 10 mmHg compared with those patients with a mean LA pressure < 10 mmHg), despite a similarity in the left ventricular ejection fraction. Conclusions: Elevated LA pressure is associated with post-PVI AF recurrence. Therefore, measuring LA pressure before PVI might be useful in identifying patients at risk for post-ablation AF recurrence, and an aggressive ablation strategy might be needed for these patients.

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The Impact of Elevated Left Atrial Pressure in Sinus Rhythm After Cardioversion on Outcomes After Catheter Ablation for Atrial Fibrillation

Abstract: Elevated LAP after cardioversion is associated with poor outcome after CA of AF. Sustained pressure overload of the LA in SR could be a cause of the recurrent AF.

Cited by 15 publications

References 22 publications

Blanking Period Phenomenon After a Second Atrial Fibrillation Ablation Session: The Application and Factors Related to It

Blanking Period Phenomenon After a Second Atrial Fibrillation Ablation Session: The Application and Factors Related to It

Effect of catheter ablation on pre-existing abnormalities of left atrial systolic, diastolic, and neurohormonal functions in patients with chronic heart failure and atrial fibrillation

Association between Elevated Left Atrial Pressure and Poor Prognosis after PVI for Atrial Fibrillation

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