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

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13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)47-52
Number of pages6
JournalJournal of Interventional Cardiac Electrophysiology
Volume40
Issue number1
DOIs
StatePublished - Jun 2014

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Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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