Key result
High left atrial pressure rise during AF ablation linked to ~8-fold higher 1-year HF hospitalization.
Why the study?
The clinical implication of left atrial pressure elevation during atrial fibrillation ablation remains uncertain.
Does high intraprocedural left atrial pressure elevation predict heart failure hospitalization in patients undergoing their first atrial fibrillation ablation?
Cohort (n=189)
Does high intraprocedural left atrial pressure elevation predict heart failure hospitalization in patients undergoing their first atrial fibrillation ablation?
Absolute Event Rate: 8.5% vs 1.1%
p-value: p=0.020
Intraprocedural left atrial pressure elevation ≥4 mmHg during first AF ablation is associated with a significantly higher risk of heart failure hospitalization within 1 year.
May prompt closer post-ablation HF surveillance; leaves open causal role and intervention targets.
Background: The clinical implication of left atrial pressure (LAP) elevation during atrial fibrillation (AF) ablation remains uncertain. Methods and Results: We retrospectively analyzed 189 patients undergoing their first AF thermal ablation. LAP was measured via the transseptal sheath at insertion (initial) and withdrawal (final), showing a median intraprocedural elevation of 4 mmHg (interquartile range 1-6). Patients were dichotomized by the median intraprocedural change (high LAP increase: ≥4 mmHg, n=95; low LAP increase: <4 mmHg, n=94). The primary endpoint was heart failure (HF) hospitalization within 1 year, and the secondary endpoint included identifying predictors with a high LAP increase. Procedural characteristics were similar. Although initial LAP values were comparable between groups, patients with a high LAP increase exhibited higher right atrial pressure (RAP) and RAP/LAP ratio (0.9±0.3 vs. 0.7±0.2; P<0.001). The cumulative incidence of HF hospitalization was significantly higher in the high LAP increase group (8.5% [95% confidence interval (CI) 2.7-13.9] vs. 1.1% [95% CI 0-3.2]; P=0.020). On multivariate analysis, female sex, persistent AF, higher body mass index, higher initial RAP/LAP ratio, and structural heart disease were independent predictors of a high LAP increase. Conclusions: Intraprocedural LAP elevation was associated with a higher risk of HF hospitalization within 1 year after the procedure. Monitoring LAP at both the start and end of ablation provides a feasible approach for post-procedural risk stratification.
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Nakashima et al. (2025) conducted a cohort in Atrial fibrillation (n=189). High intraprocedural left atrial pressure (LAP) increase (≥4 mmHg) vs. Low LAP increase (<4 mmHg) was evaluated on Heart failure (HF) hospitalization within 1 year (p=0.020). High intraprocedural left atrial pressure increase (≥4 mmHg) during AF ablation was associated with a higher rate of heart failure hospitalization at 1 year (8.5% vs 1.1%; P=0.020).
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