Intraprocedural Left Atrial Pressure Elevation and Risk of Heart Failure Events After Atrial Fibrillation Ablation

Abstract

Background: The clinical implication of left atrial pressure (LAP) elevation during atrial fibrillation (AF) ablation remains uncertain.

Methods and results: We retrospectively analyzed 189 patients undergoing their first AF thermal ablation. LAP was measured via the transseptal sheath at insertion (initial) and withdrawal (final), showing a median intraprocedural elevation of 4 mmHg (interquartile range 1-6). Patients were dichotomized by the median intraprocedural change (high LAP increase: ≥4 mmHg, n=95; low LAP increase: <4 mmHg, n=94). The primary endpoint was heart failure (HF) hospitalization within 1 year, and the secondary endpoint included identifying predictors with a high LAP increase. Procedural characteristics were similar. Although initial LAP values were comparable between groups, patients with a high LAP increase exhibited higher right atrial pressure (RAP) and RAP/LAP ratio (0.9±0.3 vs. 0.7±0.2; P<0.001). The cumulative incidence of HF hospitalization was significantly higher in the high LAP increase group (8.5% [95% confidence interval (CI) 2.7-13.9] vs. 1.1% [95% CI 0-3.2]; P=0.020). On multivariate analysis, female sex, persistent AF, higher body mass index, higher initial RAP/LAP ratio, and structural heart disease were independent predictors of a high LAP increase.

Conclusions: Intraprocedural LAP elevation was associated with a higher risk of HF hospitalization within 1 year after the procedure. Monitoring LAP at both the start and end of ablation provides a feasible approach for post-procedural risk stratification.

Keywords: Atrial fibrillation; Catheter ablation; Heart failure; Left atrial pressure; Pulmonary vein isolation.