Abstract 14837: Increase in Left Atrial Pressure After Cryoballoon Ablation Indicates Worse Atrial Function: Evidence From APPEARANCE-AF Trial
Zhongyuan Ren, Shubin wu, Jiayu Wu, Yuan Zhong, Jun Xu, Hui Sun, Dongdong Zhao, Yawei Xu- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Left atrial pressure (LAP) is a direct reflection of left atrial function, while LAP could fluctuate following left atrial procedure. The pattern of LAP change in response to pulmonary vein isolation (PVI) and its significance remain to be explored.
Hypothesis: The change of LAP before and after PVI could indicate atrial function and predict adverse events.
Methods: 28 patients from APPEARANCE-AF trial underwent PVI using cryoballoon ablation were included. Pre-ablation and post-ablation LAP were directly measured via catheter. The correlation of LAP change with demographics, biochemical measurements, and speckle traced echocardiographic indexes of left atrium (LA) were investigated.
Results: The included cohort has a mean age of 73.8±8.4 years old, with 12 male (42.9%). Instant PVI was achieved in all patients without complications. The average mean LAP (mLAP) measured before and after PVI was 8.2±4.5 mmHg (pre mLAP) and 14.0±6.5 mmHg (post mLAP), with a significant increment (ΔmLAP: 5.8±4.5 mmHg, P<0.001). In the evaluation of the association of LAP with LA function, the change in LAP significantly correlated with LA strain rate in reservoir (LASr, r=-0.58, P=0.001) and conduit phase (LAScd, r=0.63, P<0.001) and LA ejection fraction (r=-0.48, P=0.014). Furthermore, we divided the cohort into group with significant increment of LAP (inc-mLAP, increment of mLAP > 5 mmHg, n=14) and group with non-significant increment of LAP (ninc-mLAP, mLAP ≤ 5 mmHg, n=14). Correspondingly, patients with larger LAP increment presented significant worse atrial function indicated by LASr (17.3%±5.6% ninc-mLAP vs 11.5%±7.3% inc-mLAP, P=0.030), LAScd (-9.6%±2.2% ninc-mLAP vs -5.7%±3.6% inc-mLAP, P=0.003).
Conclusions: PVI could significantly increase LAP, and a higher change of LAP could indicate worse atrial function. Measuring the change of LAP might be valuable in predicting the prognosis of PVI.