Impact of pulmonary artery pressure on recurrence after catheter ablation in patients with atrial fibrillation

Figures

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  Figure 1. Measurement of pulmonary artery systolic pressure. Example of measurements of pulmonary artery systolic pressure <35 and ≥35 mmHg. The mean tricuspid regurgitation velocity was estimated by measuring the TR velocity of four or more beats. To evaluate the estimation of pulmonary pressure, right atrial pressure was assessed by measuring the diameter of the inferior vena cava (yellow arrow) and the respiratory collapse during inspiration (blue arrow). Pulmonary artery systolic pressure was estimated using the following formula. (A) In the case of PAP <35 mmHg, the mean TR velocity was 2.1 m/s and IVC almost completely collapsed during inspiration. So, pulmonary artery systolic pressure was 22.6 mmHg. (B) In the case of PAP ≥35 mmHg, the mean TR velocity was 3.2 m/s and IVC collapsed to less than 50% during inspiration. So, pulmonary artery systolic pressure was 55.9 mmHg. TR, tricuspid regurgitation; IVC, inferior vena cava; PAP, pulmonary artery pressure.

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  Figure 2. Flow of the study design. Among 2,379 consecutive patients who underwent RFCA for AF, 1,294 (54.4%) had PAF. According to the stratification based on PAP, 78% of patients with PAF had a PAP <35 mmHg. RFCA, radiofrequency catheter ablation; AF, atrial fibrillation; PAP, pulmonary artery pressure; PAF, paroxysmal atrial fibrillation; PsAF, persistent atrial fibrillation.

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  Figure 3. Scatter plot of the relation between PAP and LA. The scatter plot shows the relationship between PAP and (A) LA diameter, (B) LA volume, and (C) LVEF. (D) Bar graph shows that patients with PAP ≥35 mmHg were more likely to have paroxysmal AF. PAP, pulmonary artery pressure; LA, left atrial; AF, atrial fibrillation.

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  Figure 4. Kaplan–Meier analysis of freedom from recurrence according to PAP. Kaplan–Meier analysis with log-rank test was performed to compare freedom from recurrence. Patients with PAP ≥35 mmHg showed a significantly higher recurrence rate than those with PAP <35 mmHg. RFCA, radiofrequency catheter ablation; AF, atrial fibrillation; PAP, pulmonary artery pressure.

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  Figure 5. Kaplan–Meier analysis of freedom from recurrence according to AF type. Kaplan–Meier analysis with log-rank test was performed to compare freedom from recurrence rate. Among patients with paroxysmal AF, the recurrence rate was significantly higher in those with PAP ≥35 mmHg than in those with PAP <35 mmHg. However, among patients with persistent AF, the recurrence rate was not significantly different between the two groups. RFCA, radiofrequency catheter ablation; AF, atrial fibrillation; PAP, pulmonary artery pressure; PAF, paroxysmal atrial fibrillation; PsAF, persistent atrial fibrillation.