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Stiff Left Atrial Syndrome Following Catheter Ablation for Atrial Fibrillation: Clinical Characterization, Prevalence and Predictors.
MedLine Citation:
PMID:  21354332     Owner:  NLM     Status:  Publisher    
BACKGROUND: There have been no studies of atrial diastolic function following catheter ablation. We observed a few patients with symptomatic left atrial diastolic dysfunction with associated pulmonary hypertension that developed following catheter ablation for atrial fibrillation. Similar findings were described in patients following cardiac surgery and referred to as the "stiff left atrial syndrome". OBJECTIVE: We prospectively quantify the incidence of patients developing PH associated with diastolic hemodynamic abnormalities of the LA following radiofrequency ablation of atrial fibrillation. and to identify the possible predictors. METHODS: Between January 2009 and July 2010, data on 1380 consecutive patients were prospectively collected. Before ablation and at follow up, all patients had an Echocardiogram to assess for the presence of pulmonary hypertension. Patients with no echocardiographic evidence of PH but complaining of unexplained dyspnea with LA diastolic abnormalities were evaluated with right heart catheterization (RHC). Patients were included in the analysis if they developed new or worsening PH post ablation with evidence of LA diastolic dysfunction by RHC or direct LA pressure measurement. All patients were evaluated for pulmonary vein stenosis and excluded if this condition was identified. RESULTS: The mean age was 62±11 (75% male) and non-paroxysmal AF was the predominant arrhythmia (71%). New or worsening PH with associated LA diastolic abnormalities was detected in 19 (1.4%) patients after ablation. The prevalence of PH did not differ between AF types (p=0.612). Compared to patients who did not develop PH, LA scarring (p<0.001), diabetes (p=0.026), and obstructive sleep apnea (OSA, p=0.006) were more frequently observed among those who developed PH. In a multivariable logistic model, pre-procedure LA size < 45mm (OR=6.13, p=0.033), mean LA pressure (OR 1.14, p =0.025), severe LA scarring (OR=4.4, p=0.046), diabetes mellitus (OR=9.5, p=0.004), and obstructive sleep apnea (OR=6.2, p=0.009) were independently associated with the development of PH post ablation. CONCLUSIONS: Following RFCAF, PH with left atrial diastolic dysfunction or the so called "Stiff Left Atrial Syndrome" is rare but is a potential complication. Severe LA scarring, LA ≤ 4.5 cm, diabetes mellitus, obstructive sleep apnea and high LA pressure are clinical variables that predict the development of this syndrome. The principal clinical findings include dyspnea, CHF, pulmonary hypertension, and large V waves on PCWP or LA pressure tracings in the absence of mitral regurgitation.
Douglas N Gibson; Luigi Di Biase; Prasant Mohanty; Jigar D Patel; Rong Bai; Javier Sanchez; J David Burkhardt; J Thomas Heywood; Allen D Johnson; David S Rubenson; Rodney Horton; G Joseph Gallinghouse; Salwa Beheiry; Guy P Curtis; David N Cohen; Mark Y Lee; Michael R Smith; Devi Gopinath; William R Lewis; Andrea Natale
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-23
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Department of Cardiovascular Diseases and Interventional Electrophysiology Scripps Clinic, San Diego, California, USA.
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