Background:
Atrial fibrillation (AF) is associated with left atrial (LA) remodeling caused by LA pressure or volume (LAV) overload represented by the elevated left ventricular filling pressure or LA enlargement. Pulmonary capillary wedge pressure (PCWP) as well as LAV may be useful predictor for successful outcome of AF ablation. The aim of the study was to elucidate the most useful predictor for successful outcome in AF ablation including PCWP measured by a speckle tracking echocardiography (STE).
Methods:
We measured LAV, LA emptying function (EF), strain and strain rate (SR) by the STE during sinus rhythm before ablation in 137 patients with paroxysmal AF (61±10 years, 80 men) who underwent pulmonary vein isolation. The parameters were compared between non-recurrence (successful) group (n=107, age 61±11, sinus rhythm was continued for more than 1 year) and recurrence group (n=30, age 60±10). The estimated PCWP (ePCWP) was determined as 10.7 - 12.4 x log (active LAEF / minimum LAV), as we previously reported. LA stiffness was calculated as ePCWP/LA strain. We also measured PCWP and LA pressure by cardiac catheterization just before AF ablation in 59 patients.
Results:
The ePCWP was correlated with PCWP measured by cardiac catheterization (r=0.71, p<0.01). The ePCWP and maximum LAV before ablation in recurrence group increased compared with non-recurrence group (15±3 vs. 11±4 mmHg, and 58±15 vs. 49±15 ml/m2, respectively). LA total and active EF decreased, and LA stiffness increased in recurrence group (39±10 vs. 44±11%, 20±7 vs. 25±10% and 0.83±0.59 vs. 0.47±0.33). In multivariate analysis, ePCWP was independently associated with successful ablation best among LAEF, active EF, maximum LAV and ePCWP. Using 13 mmHg of ePCWP as a cutoff, the sensitivity and specificity for successful ablation were 77 and 73% and the positive and negative predictive value were 44 and 92% (AUC= 0.81).
Conclusion:
Elevation of ePCWP before AF ablation was the best predictor of AF recurrence after AF ablation. This suggested a strong relation between LV filling pressure and the progression of LA remodeling responsible for AF. The ePCWP estimated by STE is useful to predict the successful outcome of AF ablation.
Estimated pulmonary capillary wedge pressure assessed by speckle tracking echocardiography predicts successful ablation in paroxysmal atrial fibrillation
