title: The Impact of Elevated Left Atrial Pressure in Sinus Rhythm After Cardioversion on Outcomes After Catheter Ablation for Atrial Fibrillation.
abstract: Some patients with atrial fibrillation (AF) exhibit elevated left atrial pressure (LAP) in sinus rhythm (SR). The aim of the study was to investigate whether LAP changes between SR and AF are associated with outcomes after catheter ablation (CA) for AF.
  
  
  
  We retrospectively studied 110 patients (70 men, 66 ± 8 years, 37 with non-paroxysmal AF) who underwent CA of AF. In all patients, AF was induced by programmed stimulation and then terminated with cardioversion during CA. LAP was measured in SR and AF. The LAPSR-AF was defined as the difference between mean LAP in SR and mean LAP in AF (mean LAPSR - mean LAPAF ). Recurrence of AF after CA was detected in 37/110 patients (33.6%) during the follow-up period (13 ± 5 months). Univariate analysis revealed higher LAPSR-AF , larger left atrial diameter, and persistent AF (PeAF) as significant variables. On multivariate analysis, higher LAPSR-AF and PeAF were independently associated with recurrence of AF after CA. All patients were divided into the non-elevated LAPSR-AF group (LAPSR-AF <0 mmHg) or the elevated LAPSR-AF group (LAPSR-AF ≥0 mmHg) using the optimal cut-off value of LAPSR-AF . During a mean follow-up period of 13 ± 5 months, the AF recurrence ratio was higher in the elevated LAPSR-AF group than in the non-elevated LAPSR-AF group (20/42 patients, 48% vs. 17/68 patients, 25%, log-rank, P = 0.0306).
  
  
  
  Elevated LAP after cardioversion is associated with poor outcome after CA of AF. Sustained pressure overload of the LA in SR could be a cause of the recurrent AF.
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kishima
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takanao
authors.initials: T
authors.lastname: Mine
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Kenki
authors.initials: K
authors.lastname: Ashida
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D062185:Atrial Pressure; D017115:Catheter Ablation / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; cardioversion; left atrial pressure; pulmonary vein isolation