title: Left atrial lesion formation and volume overload by open irrigation ablation technology during pulmonary vein antrum isolation: acute effects on cardiac hemodynamics.
abstract: OBJECTIVE
  Our goal was to evaluate acute effects of left atrial lesion formation and volume overload on hemodynamics during pulmonary vein antrum isolation (PVAI) as it might be a potential cause of acute pulmonary edema.
  
  
  METHODS
  In consecutive patients presenting for PVAI, open irrigation ablation was performed (50 W, 48°C, 15 s lesion duration, saline flow rate 30 mL/min). Blood samples were drawn from the left atrium and the pulmonary artery immediately before and 30 min after PVAI. The cardiac output (CO) and stroke volume (SV) were calculated by the method of Fick.
  
  
  RESULTS
  We included 61 (27 female, 61 ± 11 years) patients suffering from paroxysmal (px; 33) or persistent (per; 28) atrial fibrillation (AF) in this study. A total of 2,917 ± 242 mL of volume was infused (2,651 ± 223 mL pxAF vs. 3,184 ± 255 mL perAF, (p < 0.01)). Total ablation time was 60 ± 7 min (52 ± 7 min in pxAF vs. 69 ± 8 min in perAF; (p < 0.001)). CO increased from 5.2 ± 1.3 to 6.2 ± 1.5 L/min (p < 0.001) during PVAI (5.7 ± 1.3 to 6.5 ± 1.7 L/min in pxAF; (p < 0.002) and 4.8 ± 1.1 to 5.9 ± 1.2 L/min in perAF; (p < 0.001)). SV increased from 74 ± 24 to 83 ± 21 mL (p < 0.005) during PVAI, and subgroups showed an increase of 82 ± 23 to 88 ± 22 mL in pxAF (p < 0.009) and 62 ± 21 to 76 ± 16 mL in perAF (p < 0.009).
  
  
  CONCLUSIONS
  From our preliminary experience, left atrial scarring and volume overload during PVAI do not seem to impact negatively hemodynamics. On the contrary, an improvement in cardiac output was documented acutely independent of type of AF.
authors.affiliation: Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany. georgnoelker@yahoo.com
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Klaus Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Guido
authors.initials: G
authors.lastname: Ritscher
authors.forename: Harald
authors.initials: H
authors.lastname: Rittger
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.forename: Johannes
authors.initials: J
authors.lastname: Heintze
authors.forename: Bogdan
authors.initials: B
authors.lastname: Muntean
authors.forename: Jürgen
authors.initials: J
authors.lastname: Vogt
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.forename: Anil Martin
authors.initials: AM
authors.lastname: Sinha
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011654:Pulmonary Edema / Q000517:prevention & control; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome