title: Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation.
abstract: BACKGROUND
  It is suggested that an elevated left atrial pressure (LAP) promotes ectopic beats emanating in the pulmonary veins (PVs) and that LAP might be a marker for structural remodeling. This study aimed to identify if the quantification of LAP correlates with structural changes of the LA and may therefore be associated with outcomes following pulmonary vein isolation (PVI).
  
  
  METHODS
  We analysed data from 120 patients, referred to PVI due to drug-refractory atrial fibrillation (AF) (age 63±8; 57% men). The maximum (mLAP) and mean LAP (meLAP) were measured after transseptal puncture.
  
  
  CONCLUSIONS
  Within a mean follow-up of 303±95 days, 60% of the patients maintained in sinus rhythm after the initial procedure and 78% after repeated PVI. Performing univariate Cox-regression analysis, type of AF, LA-volume (LAV), mLAP and the meLAP were significant predictors of recurrence after PVI (p=0.03; p=0.001; p=0.01). In multivariate analysis mLAP>18mmHg, LAV>100 ml and the presence of persistent AF were significant predictors (p=0.001; p=0.019; p=0.017). The mLAP >18 mmHg was associated with a hazard ratio of 3.8. Analyzing receiver-operator characteristics, the area under the curve for mLAP was 0.75 (p<0.01). mLAP >18 mmHg predicts recurrence with a sensitivity of 77 % and specificity of 60 %. There was a linear correlation between the LAV from MDCT and mLAP (p = 0.01, R2 = 0.61). The mLAP measured invasively displays a significant predictor for AF recurrence after PVI. There is a good correlation between LAP and LAV and both factors may be useful to quantify LA remodeling.
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Leonard
authors: L
authors: Bergau
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Dirk
authors: D
authors: Vollmann
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Lars
authors: L
authors: Luthje
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Jan Martin
authors: JM
authors: Sohns
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Joachim
authors: J
authors: Seegers
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Christian
authors: C
authors: Sohns
authors: Dept. of Cardiology and Pneumology, Heart Center, Georg-August-University of Gottingen, Gottingen, Germany.
authors: Markus
authors: M
authors: Zabel
keywords: atrial fibrillation; left atrial pressure; left atrial volume; predictors; pulmonary vein ablation; remodeling