title: Left atrial pressure as predictor for recurrence of atrial fibrillation after pulmonary vein isolation.
abstract: OBJECTIVE
  Identification of reliable risk factors for recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) has important implications. Left atrial (LA) pressure is a largely observator-independent parameter that can easily be determined after transseptal puncture. The purpose of this study was to investigate the predictive value of LA pressure for AF recurrence after PVI.
  
  
  METHODS
  Two hundred five consecutive patients with paroxysmal or persistent AF scheduled for first PVI were included. Baseline clinical data were collected. During PVI, LA pressure was determined invasively after transseptal puncture. PVI was performed with radiofrequency or cryoenergy, and patients were followed for 25 ± 7 months.
  
  
  RESULTS
  One hundred five (51 %) patients had AF recurrence. Patients with persistent AF prior to ablation had significantly more recurrences than patients with paroxysmal AF (70.1 vs. 42.0 %, p < 0.001). Mean LA pressure was significantly higher in patients with recurrence of AF (13.4 ± 7.1 vs. 11.0 ± 5.2 mmHg, p = 0.007), as was mean LA volume index (40.1 ± 18.5 vs. 33.0 ± 11.2 mL/m(2), p < 0.001). In the multivariate analysis, mean LA pressure was predictive in patients with normal or mildly enlarged LA, while AF type was not predictive. For each 1-mmHg increase in LA pressure, the risk of AF recurrence increased by 11 % in this subgroup. In patients with moderately or severely enlarged LA, AF type was predictive whereas LA pressure was not.
  
  
  CONCLUSIONS
  LA pressure, AF type, and LA volume index are independent predictors for recurrence of AF after PVI. LA pressure may be helpful especially in patients with small atria, where AF type is not predictive.
authors.affiliation: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund Freud-Str. 25, 53105, Bonn, Germany, markus.linhart@ukb.uni-bonn.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Linhart
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mittmann-Braun
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Karbach
authors.forename: René P
authors.initials: RP
authors.lastname: Andrié
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Jens
authors.initials: J
authors.lastname: Kreuz
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schrickel
authors.forename: Lars M
authors.initials: LM
authors.lastname: Lickfett
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D062185:Atrial Pressure; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006325:Heart Atria; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome