title: Increase in pulmonary arterial pressure after atrial fibrillation ablation: incidence and associated findings.
abstract: OBJECTIVE
  The stiff left atrial (LA) syndrome is defined as pulmonary hypertension (PH) secondary to reduced LA compliance and has recently been shown to be one cause of PH after atrial fibrillation (AF) ablation. We aimed to determine the incidence of an increase in pulmonary arterial (PA) pressure post-ablation and examine the clinical and echocardiographic associations.
  
  
  METHODS
  Patients who underwent AF ablation between 1999 and 2011 were included if they had both an echocardiogram pre-ablation and 3 months post-ablation. Patients were then separated into two groups with the increased PA pressure group defined as patients with >10 mmHg increase in right ventricular systolic pressure (RVSP) post-ablation and a post-ablation RVSP >35 mmHg.
  
  
  RESULTS
  Of the 499 patients meeting the study criteria, 41 (8.2%) had an increase in RVSP >10 mmHg and RVSP >35 mmHg post-ablation. On echocardiogram, the two groups had similar E/A and E/e' ratios pre-ablation. However, post-ablation, the increased PA pressure group had higher E/A (2.12 vs. 1.49, p < 0.01) and E/e' (14.7 vs. 11.2, p < 0.01) ratios. LA expansion index values were lower in the increased PA pressure group pre-ablation (51 vs. 92%, p < 0.01), but not significantly different post-ablation (82 vs. 88%, p = 0.44).
  
  
  CONCLUSIONS
  Around 8% of patients develop an increase in estimated PA pressure after AF ablation. Echocardiographic parameters suggest that patients who develop increased PA pressure are developing (or unmasking) left ventricular diastolic dysfunction.
authors: Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, witt.chance@mayo.edu.
authors: Chance M
authors: CM
authors: Witt
authors: Eric R
authors: ER
authors: Fenstad
authors: Yong-Mei
authors: YM
authors: Cha
authors: Garvan C
authors: GC
authors: Kane
authors: Sudhir S
authors: SS
authors: Kushwaha
authors: David O
authors: DO
authors: Hodge
authors: Samuel J
authors: SJ
authors: Asirvatham
authors: Jae K
authors: JK
authors: Oh
authors: Douglas L
authors: DL
authors: Packer
authors: Brian D
authors: BD
authors: Powell
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects*; D003187:Compliance; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000503:physiopathology; D013577:Syndrome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging