The Impact of Elevated Left Atrial Pressure in Sinus Rhythm After Cardioversion on Outcomes After Catheter Ablation for Atrial Fibrillation

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Some patients with atrial fibrillation (AF) exhibit elevated left atrial pressure (LAP) in sinus rhythm (SR). The aim of the study was to investigate whether LAP changes between SR and AF are associated with outcomes after catheter ablation (CA) for AF.

Methods and Results:

We retrospectively studied 110 patients (70 men, 66 ± 8 years, 37 with non-paroxysmal AF) who underwent CA of AF. In all patients, AF was induced by programmed stimulation and then terminated with cardioversion during CA. LAP was measured in SR and AF. The LAPSR-AF was defined as the difference between mean LAP in SR and mean LAP in AF (mean LAPSR – mean LAPAF). Recurrence of AF after CA was detected in 37/110 patients (33.6%) during the follow-up period (13 ± 5 months). Univariate analysis revealed higher LAPSR-AF, larger left atrial diameter, and persistent AF (PeAF) as significant variables. On multivariate analysis, higher LAPSR-AF and PeAF were independently associated with recurrence of AF after CA. All patients were divided into the non-elevated LAPSR-AF group (LAPSR-AF <0 mmHg) or the elevated LAPSR-AF group (LAPSR-AF ≥0 mmHg) using the optimal cut-off value of LAPSR-AF. During a mean follow-up period of 13 ± 5 months, the AF recurrence ratio was higher in the elevated LAPSR-AF group than in the non-elevated LAPSR-AF group (20/42 patients, 48% vs. 17/68 patients, 25%, log-rank, P = 0.0306).


Elevated LAP after cardioversion is associated with poor outcome after CA of AF. Sustained pressure overload of the LA in SR could be a cause of the recurrent AF.

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