title: The effect of open-irrigated radiofrequency catheter ablation of atrial fibrillation on left atrial pressure and B-type natriuretic peptide.
abstract: BACKGROUND
  Open-irrigated radiofrequency catheter ablation (oiRFA) of atrial fibrillation (AF) imposes a volume load and risk of pulmonary edema. We sought to assess the effect of volume administration during ablation on left atrial (LA) pressure and B-type natriuretic peptide (BNP).
  
  
  METHODS
  LA pressure was measured via transseptal sheath at the beginning and end of 44 LA ablation procedures in 42 patients. BNP plasma levels were measured before and after 10 procedures.
  
  
  RESULTS
  A median of 3,255 (interquartile range [IQR], 2,014)-mL saline was administered during the procedure. During LA ablation, the median fluid balance was +1,438 (IQR, 1,109) mL and LA pressure increased by median 3.7 (IQR, 5.9) mm Hg (P < 0.001). LA pressure did not change in the 19 procedures with furosemide administration (median ΔP = -0.3 [IQR, 7.1] mm Hg, P = 0.334). The correlation of LA pressure and fluid balance was weak (rs = 0.383, P = 0.021). BNP decreased in all four procedures starting in AF or atrial tachycardia and then converting to sinus rhythm (P = 0.068), and increased in all six procedures starting and finishing in sinus rhythm (P = 0.028). After ablation, symptomatic volume overload responding to diuresis occurred in three patients.
  
  
  CONCLUSIONS
  A substantial intravascular volume load during oiRFA can be absorbed with little change in LA pressure, such that LA pressure is not a reliable indicator of the fluid balance. Subsequent redistribution of the volume load imposes a risk after the procedure. Conversion to sinus rhythm may improve ability to acutely accommodate the volume load.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jens
authors.initials: J
authors.lastname: Seiler
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Roberts-Thomson
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D062185:Atrial Pressure; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; atrial fibrillation; left atrial pressure; open irrigation; radiofrequency catheter ablation