title: Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle?
abstract: Atrial fibrillation is the most common heart rhythm disorder in United States, characterised by rapid and irregular beating of both the atria resulting in the similar ventricular response. While rate and rhythm control using pharmacological regimens remain the primary management strategies in these patients, radiofrequency catheter ablation (RFCA) is rapidly rising as an alternative modality of treatment. Increase in the incidence of RFCA has shed light on complications associated with this procedure. Pulmonary hypertension (PH) is one of the long-term complications that has been observed postcatheter ablation. There have been multiple mechanisms which have been proposed to explain these elevated pulmonary pressures. These include the involvement of the lungs due to pulmonary vein stenosis, pulmonary vein occlusion and, rarely, pulmonary embolism. Radiofrequency catheter ablation can also lead to scarring of the atrium which can cause left atrial diastolic dysfunction leading to elevated pulmonary pressures. Recently, it was also proposed that elevated pulmonary pressure was related to the unmasking of left ventricular diastolic dysfunction occurring after this procedure. In this article, we review all the mechanisms that are associated with the development of pulmonary hypertension in patients undergoing RCFA for atrial fibrillation and the approach to diagnosis and management of such patients.
authors.affiliation: Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA.
authors.forename: Isha
authors.initials: I
authors.lastname: Verma
authors.affiliation: Alvin and Lois Lapidus Cancer Institute, Sinai Hospital of Baltimore, Maryland, USA.
authors.forename: Hemantkumar
authors.initials: H
authors.lastname: Tripathi
authors.affiliation: Department of Anesthesiology Lilavati Hospital & Research Center, Mumbai, India.
authors.forename: Rutuja Rajanikant
authors.initials: RR
authors.lastname: Sikachi
authors.affiliation: Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA; Northwell Health - Hofstra Northwell School of Medicine Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York, USA. Electronic address: abhinav72@gmail.com.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Agrawal
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*
keywords: Atrial fibrillation; PVS; Pulmonary hypertension; RFCA; Stiff Atrial Syndrome