Association between Elevated Left Atrial Pressure and Poor Prognosis after PVI for Atrial Fibrillation

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Objective: Left atrial (LA) stretch attributable to elevated LA pressure is known to play an important role in the perpetuation of atrial fibrillation (AF). However, the relation between LA pressure and the outcome of pulmonary vein isolation (PVI) for AF remains to be elucidated. Therefore, we investigated the relationships between postPVI recurrence of AF, LA pressure, and pre-ablation variables. Methods and Results: The study group comprised 60 consecutive patients who were undergoing ablation for AF (46 men, 14 women; mean age, 59.5 ± 11 years; paroxysmal AF [PAF], n = 35; persistent AF [Per AF], n = 25). The patient characteristics and biomarkers of inflammation, fibrosis and heart failure measured before ablation were compared between patients in whom AF recurred after a 3-month blanking period and those in whom it did not. No significant differences were found in clinical or echocardiographic variables or biomarker concentrations between the patients with and without recurrence. However, the mean LA pressure was elevated in patients in whom AF recurred (12.2 ± 0.99 vs. 7.99 ± 0.62 mmHg, respectively, P < 0.001). Body mass index and serum atrial natriuretic peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were higher; hypertension was more prevalent, and the LA diameter and volume were greater in patients with a mean LA pressure ? the median value of 10 mmHg compared with those patients with a mean LA pressure < 10 mmHg), despite a similarity in the left ventricular ejection fraction. Conclusions: Elevated LA pressure is associated with post-PVI AF recurrence. Therefore, measuring LA pressure before PVI might be useful in identifying patients at risk for post-ablation AF recurrence, and an aggressive ablation strategy might be needed for these patients.