High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation

Junbeom Park; Boyoung Joung; Jae Sun Uhm; Chi Young Shim; Chun Hwang; Moon Hyoung Lee; Hui Nam Pak

doi:10.1016/j.hrthm.2014.03.009

High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation

Junbeom Park, Boyoung Joung, Jae Sun Uhm, Chi Young Shim, Chun Hwang, Moon Hyoung Lee, Hui Nam Pak

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

103 Scopus citations

Abstract

Background The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients with atrial fibrillation (AF). Objective To explore the effects of elevated LAP on pathophysiology and clinical outcome after radiofrequency catheter ablation in patients with AF. Methods We measured LAP during both sinus rhythm (SR) and AF in 454 patients 348 (76.7%) men; mean age 58 ± 11 years; 326(71.8%) paroxysmal AF) who underwent radiofrequency catheter ablation and compared LAP at v wave (LAP_peak) and LAP at y descent (LAP_nadir) by using imaging (echocardiography and computed tomography), electrophysiologic mapping (NavX), and clinical data. In 280 (61.7%) patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by transesophageal echocardiography. Results Patients with LAP _peak(SR) ≥19 mm Hg had greater left atrial (LA) dimension (P <.001), LA volume index (P =.003), and E/Em (mitral annular septal area [peak diastolic velocity]; P =.001) but reduced LA voltage (P <.001) and mitral annular septal area (peak systolic velocity; P =.006) compared with patients with LAP_peak(SR) <19 mm Hg. High LAP_peak(SR) was independently associated with anterior LA volume (linear regression coefficient [B] = 0.381; 95% confidence interval [CI] 0.169-0.593; P <.001) and low LA voltage (B = -0.022; 95% CI -0.030 to -0.013; P <.001). PV diastolic flow velocity (B = 0.161; 95% CI 0.083-0.239; P <.001) and E/Em (B = 0.430; 95% CI 0.096-0.763; P =.012) were independent, noninvasive parameters associated with high LA_peak(SR). During 13.1 ± 6.0 months of follow-up, high LAP_peak(SR) was an independent predictor for clinical recurrence of AF (hazard ratio 1.887; 95% CI 1.063-3.350; P =.028). Conclusion Elevated LAP was closely associated with electroanatomical remodeling of the LA and was an independent predictor for recurrence after AF ablation. PV diastolic flow velocity and E/Em can be used as a noninvasive parameter predicting high LAP_peak(SR) in patients with AF.

Original language	English
Pages (from-to)	953-960
Number of pages	8
Journal	Heart Rhythm
Volume	11
Issue number	6
DOIs	https://doi.org/10.1016/j.hrthm.2014.03.009
State	Published - Jun 2014

Bibliographical note

Funding Information:
This work was supported by a grant ( 2012027176 ) from the Basic Science Research Program run by the National Research Foundation of Korea , which is funded by the Ministry of Science, ICT and Future Planning.

Keywords

Atrial fibrillation
Catheter ablation
Left atrial pressure
Recurrence

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10.1016/j.hrthm.2014.03.009

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@article{863dce84fc13485ea78fae600c29c97a,

title = "High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation",

abstract = "Background The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients with atrial fibrillation (AF). Objective To explore the effects of elevated LAP on pathophysiology and clinical outcome after radiofrequency catheter ablation in patients with AF. Methods We measured LAP during both sinus rhythm (SR) and AF in 454 patients 348 (76.7%) men; mean age 58 ± 11 years; 326(71.8%) paroxysmal AF) who underwent radiofrequency catheter ablation and compared LAP at v wave (LAPpeak) and LAP at y descent (LAPnadir) by using imaging (echocardiography and computed tomography), electrophysiologic mapping (NavX), and clinical data. In 280 (61.7%) patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by transesophageal echocardiography. Results Patients with LAP peak(SR) ≥19 mm Hg had greater left atrial (LA) dimension (P <.001), LA volume index (P =.003), and E/Em (mitral annular septal area [peak diastolic velocity]; P =.001) but reduced LA voltage (P <.001) and mitral annular septal area (peak systolic velocity; P =.006) compared with patients with LAPpeak(SR) <19 mm Hg. High LAPpeak(SR) was independently associated with anterior LA volume (linear regression coefficient [B] = 0.381; 95% confidence interval [CI] 0.169-0.593; P <.001) and low LA voltage (B = -0.022; 95% CI -0.030 to -0.013; P <.001). PV diastolic flow velocity (B = 0.161; 95% CI 0.083-0.239; P <.001) and E/Em (B = 0.430; 95% CI 0.096-0.763; P =.012) were independent, noninvasive parameters associated with high LApeak(SR). During 13.1 ± 6.0 months of follow-up, high LAPpeak(SR) was an independent predictor for clinical recurrence of AF (hazard ratio 1.887; 95% CI 1.063-3.350; P =.028). Conclusion Elevated LAP was closely associated with electroanatomical remodeling of the LA and was an independent predictor for recurrence after AF ablation. PV diastolic flow velocity and E/Em can be used as a noninvasive parameter predicting high LAPpeak(SR) in patients with AF.",

keywords = "Atrial fibrillation, Catheter ablation, Left atrial pressure, Recurrence",

author = "Junbeom Park and Boyoung Joung and Uhm, {Jae Sun} and Shim, {Chi Young} and Chun Hwang and {Hyoung Lee}, Moon and Pak, {Hui Nam}",

note = "Funding Information: This work was supported by a grant ( 2012027176 ) from the Basic Science Research Program run by the National Research Foundation of Korea , which is funded by the Ministry of Science, ICT and Future Planning. ",

year = "2014",

month = jun,

doi = "10.1016/j.hrthm.2014.03.009",

language = "English",

volume = "11",

pages = "953--960",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "6",

}

High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. / Park, Junbeom; Joung, Boyoung; Uhm, Jae Sun et al.
In: Heart Rhythm, Vol. 11, No. 6, 06.2014, p. 953-960.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation

AU - Park, Junbeom

AU - Joung, Boyoung

AU - Uhm, Jae Sun

AU - Shim, Chi Young

AU - Hwang, Chun

AU - Hyoung Lee, Moon

AU - Pak, Hui Nam

N1 - Funding Information: This work was supported by a grant ( 2012027176 ) from the Basic Science Research Program run by the National Research Foundation of Korea , which is funded by the Ministry of Science, ICT and Future Planning.

PY - 2014/6

Y1 - 2014/6

N2 - Background The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients with atrial fibrillation (AF). Objective To explore the effects of elevated LAP on pathophysiology and clinical outcome after radiofrequency catheter ablation in patients with AF. Methods We measured LAP during both sinus rhythm (SR) and AF in 454 patients 348 (76.7%) men; mean age 58 ± 11 years; 326(71.8%) paroxysmal AF) who underwent radiofrequency catheter ablation and compared LAP at v wave (LAPpeak) and LAP at y descent (LAPnadir) by using imaging (echocardiography and computed tomography), electrophysiologic mapping (NavX), and clinical data. In 280 (61.7%) patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by transesophageal echocardiography. Results Patients with LAP peak(SR) ≥19 mm Hg had greater left atrial (LA) dimension (P <.001), LA volume index (P =.003), and E/Em (mitral annular septal area [peak diastolic velocity]; P =.001) but reduced LA voltage (P <.001) and mitral annular septal area (peak systolic velocity; P =.006) compared with patients with LAPpeak(SR) <19 mm Hg. High LAPpeak(SR) was independently associated with anterior LA volume (linear regression coefficient [B] = 0.381; 95% confidence interval [CI] 0.169-0.593; P <.001) and low LA voltage (B = -0.022; 95% CI -0.030 to -0.013; P <.001). PV diastolic flow velocity (B = 0.161; 95% CI 0.083-0.239; P <.001) and E/Em (B = 0.430; 95% CI 0.096-0.763; P =.012) were independent, noninvasive parameters associated with high LApeak(SR). During 13.1 ± 6.0 months of follow-up, high LAPpeak(SR) was an independent predictor for clinical recurrence of AF (hazard ratio 1.887; 95% CI 1.063-3.350; P =.028). Conclusion Elevated LAP was closely associated with electroanatomical remodeling of the LA and was an independent predictor for recurrence after AF ablation. PV diastolic flow velocity and E/Em can be used as a noninvasive parameter predicting high LAPpeak(SR) in patients with AF.

AB - Background The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients with atrial fibrillation (AF). Objective To explore the effects of elevated LAP on pathophysiology and clinical outcome after radiofrequency catheter ablation in patients with AF. Methods We measured LAP during both sinus rhythm (SR) and AF in 454 patients 348 (76.7%) men; mean age 58 ± 11 years; 326(71.8%) paroxysmal AF) who underwent radiofrequency catheter ablation and compared LAP at v wave (LAPpeak) and LAP at y descent (LAPnadir) by using imaging (echocardiography and computed tomography), electrophysiologic mapping (NavX), and clinical data. In 280 (61.7%) patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by transesophageal echocardiography. Results Patients with LAP peak(SR) ≥19 mm Hg had greater left atrial (LA) dimension (P <.001), LA volume index (P =.003), and E/Em (mitral annular septal area [peak diastolic velocity]; P =.001) but reduced LA voltage (P <.001) and mitral annular septal area (peak systolic velocity; P =.006) compared with patients with LAPpeak(SR) <19 mm Hg. High LAPpeak(SR) was independently associated with anterior LA volume (linear regression coefficient [B] = 0.381; 95% confidence interval [CI] 0.169-0.593; P <.001) and low LA voltage (B = -0.022; 95% CI -0.030 to -0.013; P <.001). PV diastolic flow velocity (B = 0.161; 95% CI 0.083-0.239; P <.001) and E/Em (B = 0.430; 95% CI 0.096-0.763; P =.012) were independent, noninvasive parameters associated with high LApeak(SR). During 13.1 ± 6.0 months of follow-up, high LAPpeak(SR) was an independent predictor for clinical recurrence of AF (hazard ratio 1.887; 95% CI 1.063-3.350; P =.028). Conclusion Elevated LAP was closely associated with electroanatomical remodeling of the LA and was an independent predictor for recurrence after AF ablation. PV diastolic flow velocity and E/Em can be used as a noninvasive parameter predicting high LAPpeak(SR) in patients with AF.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Left atrial pressure

KW - Recurrence

UR - http://www.scopus.com/inward/record.url?scp=84901439465&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2014.03.009

DO - 10.1016/j.hrthm.2014.03.009

M3 - Article

C2 - 24607916

AN - SCOPUS:84901439465

SN - 1547-5271

VL - 11

SP - 953

EP - 960

JO - Heart Rhythm

JF - Heart Rhythm

IS - 6

ER -

High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation

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