Key result
Open-irrigated radiofrequency catheter ablation of atrial fibrillation resulted in a median fluid balance of +1,438 mL and increased left atrial pressure by a median of 3.7 mm Hg (P<0.001).
Why the study?
Does volume administration during open-irrigated radiofrequency catheter ablation for atrial fibrillation increase left atrial pressure and B-type natriuretic peptide?
Observational (n=42)
Does volume administration during open-irrigated radiofrequency catheter ablation for atrial fibrillation increase left atrial pressure and B-type natriuretic peptide?
A substantial intravascular volume load during open-irrigated radiofrequency ablation for AF can be absorbed with little change in LA pressure, indicating LA pressure is not a reliable indicator of fluid balance and highlighting a risk of post-procedure volume overload.
Highlights post-ablation volume overload risk despite modest LA pressure rise; leaves open whether LA pressure reliably tracks fluid balance.
BACKGROUND: Open-irrigated radiofrequency catheter ablation (oiRFA) of atrial fibrillation (AF) imposes a volume load and risk of pulmonary edema. We sought to assess the effect of volume administration during ablation on left atrial (LA) pressure and B-type natriuretic peptide (BNP). METHODS: LA pressure was measured via transseptal sheath at the beginning and end of 44 LA ablation procedures in 42 patients. BNP plasma levels were measured before and after 10 procedures. RESULTS: A median of 3,255 (interquartile range [IQR], 2,014)-mL saline was administered during the procedure. During LA ablation, the median fluid balance was +1,438 (IQR, 1,109) mL and LA pressure increased by median 3.7 (IQR, 5.9) mm Hg (P < 0.001). LA pressure did not change in the 19 procedures with furosemide administration (median ΔP = -0.3 [IQR, 7.1] mm Hg, P = 0.334). The correlation of LA pressure and fluid balance was weak (rs = 0.383, P = 0.021). BNP decreased in all four procedures starting in AF or atrial tachycardia and then converting to sinus rhythm (P = 0.068), and increased in all six procedures starting and finishing in sinus rhythm (P = 0.028). After ablation, symptomatic volume overload responding to diuresis occurred in three patients. CONCLUSIONS: A substantial intravascular volume load during oiRFA can be absorbed with little change in LA pressure, such that LA pressure is not a reliable indicator of the fluid balance. Subsequent redistribution of the volume load imposes a risk after the procedure. Conversion to sinus rhythm may improve ability to acutely accommodate the volume load.
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Seiler et al. (2013) conducted an observational in Atrial fibrillation (n=42). Open-irrigated radiofrequency catheter ablation (oiRFA) was evaluated on Change in left atrial pressure (p=< 0.001). Open-irrigated radiofrequency catheter ablation of atrial fibrillation resulted in a median fluid balance of +1,438 mL and increased left atrial pressure by a median of 3.7 mm Hg (P<0.001).
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