title: High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation.
abstract: BACKGROUND
  The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients with atrial fibrillation (AF).
  
  
  OBJECTIVE
  To explore the effects of elevated LAP on pathophysiology and clinical outcome after radiofrequency catheter ablation in patients with AF.
  
  
  METHODS
  We measured LAP during both sinus rhythm (SR) and AF in 454 patients 348 (76.7%) men; mean age 58 ± 11 years; 326(71.8%) paroxysmal AF) who underwent radiofrequency catheter ablation and compared LAP at v wave (LAPpeak) and LAP at y descent (LAPnadir) by using imaging (echocardiography and computed tomography), electrophysiologic mapping (NavX), and clinical data. In 280 (61.7%) patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by transesophageal echocardiography.
  
  
  RESULTS
  Patients with LAPpeak(SR) ≥19 mm Hg had greater left atrial (LA) dimension (P < .001), LA volume index (P = .003), and E/Em (mitral annular septal area [peak diastolic velocity]; P = .001) but reduced LA voltage (P < .001) and mitral annular septal area (peak systolic velocity; P = .006) compared with patients with LAPpeak(SR) <19 mm Hg. High LAPpeak(SR) was independently associated with anterior LA volume (linear regression coefficient [B] = 0.381; 95% confidence interval [CI] 0.169-0.593; P < .001) and low LA voltage (B = -0.022; 95% CI -0.030 to -0.013; P < .001). PV diastolic flow velocity (B = 0.161; 95% CI 0.083-0.239; P < .001) and E/Em (B = 0.430; 95% CI 0.096-0.763; P = .012) were independent, noninvasive parameters associated with high LApeak(SR). During 13.1 ± 6.0 months of follow-up, high LAPpeak(SR) was an independent predictor for clinical recurrence of AF (hazard ratio 1.887; 95% CI 1.063-3.350; P = .028).
  
  
  CONCLUSIONS
  Elevated LAP was closely associated with electroanatomical remodeling of the LA and was an independent predictor for recurrence after AF ablation. PV diastolic flow velocity and E/Em can be used as a noninvasive parameter predicting high LAPpeak(SR) in patients with AF.
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Chi
authors.initials: C
authors.lastname: Young Shim
authors.affiliation: Utah Valley Medical Center, Provo, Utah.
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Moon
authors.initials: M
authors.lastname: Hyoung Lee
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea. Electronic address: hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016279:Atrial Function, Left / Q000502:physiology*; D062185:Atrial Pressure / Q000502:physiology*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence
keywords: Atrial fibrillation; Catheter ablation; Left atrial pressure; Recurrence