title: Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon.
abstract: OBJECTIVE
  Several studies have demonstrated that left ventricular diastolic dysfunction (LVDD) and left atrial pressure (LAP), as a surrogate marker of LVDD, were associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) for AF. In this study, we aimed to investigate the individual impact of several left ventricular diastolic function parameters on outcomes of cryoablation for paroxysmal AF using second-generation cryoballoon.
  
  
  METHODS
  One hundred seventy patients who were scheduled for cryoablation with second-generation cryoballoon were included in this prospective study. All patients underwent comprehensive transthoracic and transesophageal echocardiographic examinations during sinus rhythm a day before catheter ablation. LAP was measured via transseptal sheath at the beginning of the ablation procedure.
  
  
  RESULTS
  One hundred seventy patients (57.09 ± 11.80 years, 47.06 % male) were involved in the study. At a median follow-up of 19 months, when blanking period of 3 months was considered, freedom from AF after a single ablation procedure was 84.71 %. Patients with AF recurrence had significantly greater left atrial volume index (LAVI) (p = 0.005) and LAP (p < 0.001). Patients with AF recurrence had lower septal e' wave (p = 0.013), and higher E/e' ratio (p = 0.014). LAVI (p = 0.007) and LAP (p = 0.006) were independent predictors of AF recurrence. A cut-off value of 13.50 mmHg for LAP measured during the procedure was associated with a sensitivity and specificity of 80.8 and 84.7 % (p = 0.005) for predicting AF recurrence.
  
  
  CONCLUSIONS
  Pre-procedural LAVI and procedural LAP measurement have clinical importance in predicting AF recurrence in patients undergoing cryoablation with second-generation cryoballoon. Effectiveness of cryoablation is reduced in patients with greater LAVI and LAP.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey. banu.evranos@yahoo.com.
authors.forename: Banu
authors.initials: B
authors.lastname: Evranos
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
authors.forename: Duygu
authors.initials: D
authors.lastname: Kocyigit
authors.affiliation: Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Kadri Murat
authors.initials: KM
authors.lastname: Gurses
authors.affiliation: Department of Cardiology, Hakkari State Hospital, Hakkari, Turkey.
authors.forename: Muhammed Ulvi
authors.initials: MU
authors.lastname: Yalcin
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
authors.forename: Mehmet Levent
authors.initials: ML
authors.lastname: Sahiner
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
authors.forename: Ergun Baris
authors.initials: EB
authors.lastname: Kaya
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
authors.forename: Necla
authors.initials: N
authors.lastname: Ozer
authors.affiliation: Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D062185:Atrial Pressure; D003452:Cryosurgery / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control
keywords: Ablation; Atrial fibrillation; Diastolic functions; Echocardiography; Left atrial pressure
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