Key result
Paradoxical left atrial pressure elevation during isoproterenol infusion in AF patients with E/Em ≥15 was independently associated with 1-year follow-up E/Em reduction (B = -4.07; P<0.001).
Why the study?
Does the rate-dependent peak left atrial pressure response to isoproterenol differ based on baseline LV diastolic function (E/Em) in patients with atrial fibrillation?
Observational (n=331)
Does the rate-dependent peak left atrial pressure response to isoproterenol differ based on baseline LV diastolic function (E/Em) in patients with atrial fibrillation?
Effect estimate: B = -4.07 (95% CI -5.41 to -2.72)
p-value: p=<0.001
In AF patients undergoing ablation, a blunted or paradoxical left atrial pressure response to isoproterenol identifies those with impaired diastolic function who are likely to have improved diastolic function at 1 year post-ablation.
May identify AF ablation patients likely to improve diastolic function; hypothesis-generating and requires prospective validation.
AIMS: A heart rate (HR)-dependent haemodynamic linkage between peak left atrial (LA) pressure during sinus rhythm (LAPpeak) and estimated left ventricular (LV) filling pressure (E/Em) has not yet been explored. We hypothesized that rate-dependent LAPpeak response differs depending on E/Em in patients with atrial fibrillation (AF). METHODS AND RESULTS: A total of 331 patients (68.0% male, 59.8 ± 10.8 years old) undergoing radiofrequency catheter ablation (RFCA) for AF were included, and their LAPpeak in sinus rhythm was recorded at the beginning of the procedure and at the HRs of 90, 100, 110, and 120 b.p.m. during right atrial pacing and isoproterenol (ISO-stress) infusion. We compared LAPpeak changes between patients with E/Em ≥ 15 (n = 58) and those with <15 (n = 273). (i) The patterns of pacing rate-dependent LAPpeak increase were similar in both the E/Em < 15 (P < 0.001) and E/Em ≥ 15 groups (P = 0.002). (ii) The ISO-stress reduced LAPpeak in patients with E/Em < 15 (P = 0.015), but not in those with E/Em ≥ 15 (P = 0.582). (iii) Paradoxical ISO-stress LAP elevation in patients with E/Em ≥ 15 was independently associated with 1-year follow-up E/Em reduction (B = -4.07, 95% CI -5.41 to -2.72, P < 0.001). Coexistence of E/Em ≥ 15 and ISO-stress LAP elevation increased specificity in predicting 1-year follow-up E/Em reduction after AF ablation than E/Em alone. CONCLUSION: Isoproterenol LAPpeak reduction was blunted in patients with impaired LV diastolic function estimated by E/Em ≥ 15. The improvement of LV diastolic dysfunction 1 year after AF ablation was independently associated with both paradoxical ISO-stress LAP elevation and E/Em ≥ 15 at the time of procedure. CLINICALTRIALSGOV: NCT02138695.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2015) conducted an observational in Atrial fibrillation (n=331). Isoproterenol infusion vs. Patients with E/Em < 15 was evaluated on 1-year follow-up E/Em reduction (B = -4.07, 95% CI -5.41 to -2.72, p=<0.001). Paradoxical left atrial pressure elevation during isoproterenol infusion in AF patients with E/Em ≥15 was independently associated with 1-year follow-up E/Em reduction (B = -4.07; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: