Left atrial pressure pattern without a-wave in sinus rhythm after cardioversion affects the outcomes after catheter ablation for atrial fibrillation

Heart Vessels. 2018 Nov;33(11):1365-1372. doi: 10.1007/s00380-018-1176-7. Epub 2018 Apr 24.

Abstract

The a-wave in left atrial pressure (LAP) is often not observed after cardioversion (CV). We hypothesized that repeated atrial fibrillation (AF) occurs in patients who do not show a-wave pattern after CV. We investigated the impact of "LAP pattern without a-wave" on the outcome after catheter ablation (CA) for AF. We studied 100 patients (64 males, age 66 ± 8 years, 42 with non-paroxysmal AF) who underwent CA for AF. Sustained- or induced-AF were terminated with internal CV, and LAP was measured during sinus rhythm (SR) after CV. LAP pattern without a-wave was defined as absence of a-wave (the "a-wave" was defined as a protruding part by 0.2 mmHg or more from the baseline) in LAP wave form. AF was terminated with CV in all patients. Recurrent AF was detected in 35/100 (35%) during the follow-up period (13.1 ± 7.8 month). Univariate analysis revealed higher prevalence of LAP pattern without a-wave (71 vs. 17%, P < 0.0001), larger left atrial volume, elevated E wave, and decreased deceleration time as significant variables. On multivariate analysis, LAP pattern without a-wave was only independently associated with recurrent AF (P = 0.0014, OR 9.865, 95% CI 2.327-54.861). Moreover, patients with LAP pattern without a-wave had a higher risk of recurrent AF than patients with a-wave (25/36 patients, 69 vs. 10/64 patients, 16%, log-rank P < 0.0001). Left atrial pressure pattern without a-wave in sinus rhythm after cardioversion could predict recurrence after catheter ablation for AF.

Keywords: Atrial fibrillation; Cardioversion; Catheter ablation; Left atrial function; Left atrial pressure.

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Atrial Function, Left / physiology*
  • Atrial Pressure / physiology*
  • Catheter Ablation / methods*
  • Coronary Angiography
  • Electric Countershock / methods*
  • Electrocardiography
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Heart Rate / physiology*
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Multidetector Computed Tomography / methods
  • Retrospective Studies
  • Surgery, Computer-Assisted / methods
  • Time Factors
  • Treatment Outcome