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Minerva Cardioangiologica 2020 Dec 01

DOI: 10.23736/S0026-4725.20.05418-3


language: English

Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence

Massimiliano MANFRIN 1, Giacomo MUGNAI 2, 3 , Gian-Battista CHIERCHIA 3, Carlo DE ASMUNDIS 3, Claudio BILATO 2, Werner RAUHE 1

1 Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy; 2 Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy; 3 Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium


BACKGROUND: The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation.
METHODS: Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg.
RESULTS: A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). Older age, LA volume and LAH were significantly associated with early AF recurrence during the blanking period. However, only LAH independently remained a significant predictor of late AF recurrence (HR 3.02, 1.36-6.72, p=0.007).
CONCLUSIONS: Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences.

KEY WORDS: Left atrial hypertension; Atrial fibrillation; Pulmonary vein isolation; Catheter ablation

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