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Increase in pulmonary arterial pressure after atrial fibrillation ablation: incidence and associated findings

  • Chance M. Witt
  • Eric R. Fenstad
  • Yong-Mei Cha
  • Garvan C. Kane
  • Sudhir S. Kushwaha
  • David O. Hodge
  • Samuel J. Asirvatham
  • Jae K. Oh
  • Douglas L. Packer
  • Brian D. Powell
Article

Abstract

Purpose

The stiff left atrial (LA) syndrome is defined as pulmonary hypertension (PH) secondary to reduced LA compliance and has recently been shown to be one cause of PH after atrial fibrillation (AF) ablation. We aimed to determine the incidence of an increase in pulmonary arterial (PA) pressure post-ablation and examine the clinical and echocardiographic associations.

Methods

Patients who underwent AF ablation between 1999 and 2011 were included if they had both an echocardiogram pre-ablation and 3 months post-ablation. Patients were then separated into two groups with the increased PA pressure group defined as patients with >10 mmHg increase in right ventricular systolic pressure (RVSP) post-ablation and a post-ablation RVSP >35 mmHg.

Results

Of the 499 patients meeting the study criteria, 41 (8.2 %) had an increase in RVSP >10 mmHg and RVSP >35 mmHg post-ablation. On echocardiogram, the two groups had similar E/A and E/e’ ratios pre-ablation. However, post-ablation, the increased PA pressure group had higher E/A (2.12 vs. 1.49, p < 0.01) and E/e’ (14.7 vs. 11.2, p < 0.01) ratios. LA expansion index values were lower in the increased PA pressure group pre-ablation (51 vs. 92 %, p < 0.01), but not significantly different post-ablation (82 vs. 88 %, p = 0.44).

Conclusions

Around 8 % of patients develop an increase in estimated PA pressure after AF ablation. Echocardiographic parameters suggest that patients who develop increased PA pressure are developing (or unmasking) left ventricular diastolic dysfunction.

Keywords

Stiff left atrial syndrome Catheter ablation Atrial fibrillation Pulmonary hypertension Stiffness Diastolic dysfunction 

Abbreviations

AF

Atrial fibrillation

LA

Left atrial or left atrium

PA

Pulmonary artery

PH

Pulmonary hypertension

RVSP

Right ventricular systolic pressure

TTE

Transthoracic echocardiogram

LV

Left ventricular

Notes

Financial support

This work was supported by the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

Potential conflicts of interest

No relevant conflicts of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Chance M. Witt
    • 1
  • Eric R. Fenstad
    • 2
  • Yong-Mei Cha
    • 2
  • Garvan C. Kane
    • 2
  • Sudhir S. Kushwaha
    • 2
  • David O. Hodge
    • 3
  • Samuel J. Asirvatham
    • 2
  • Jae K. Oh
    • 2
  • Douglas L. Packer
    • 2
  • Brian D. Powell
    • 4
  1. 1.Department of MedicineMayo ClinicRochesterUSA
  2. 2.Division of Cardiovascular DiseasesMayo ClinicRochesterUSA
  3. 3.Department of Health Sciences ResearchMayo ClinicRochesterUSA
  4. 4.Division of Cardiovascular DiseasesSanger Heart & Vascular InstituteCharlotteUSA

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