Impact of right ventricular to pulmonary artery coupling in patients undergoing catheter ablation of atrial fibrillation

AIMS: Right ventricular to pulmonary artery (RV-PA) coupling has emerged as an important determinant of prognosis in heart failure and pulmonary hypertension. However, its role in patients undergoing catheter ablation of atrial fibrillation remains uncertain. This study investigated changes in RV-PA coupling after ablation and its association with atrial fibrillation recurrence. METHODS AND RESULTS: In this multicenter prospective study, 118 patients undergoing ablation of atrial fibrillation were evaluated at baseline and after 3 months using comprehensive clinical and echocardiographic assessment. Atrial fibrillation recurrence was assessed at 1-year follow-up.After 3 months, tricuspid annular plane systolic excursion (TAPSE) increased (22.4 ± 4.1 to 24 ± 3.8, P < 0.001), pulmonary artery systolic pressure (PASP) decreased (29.5 ± 6.6 to 27.9 ± 7.7, P = 0.030), and TAPSE/PASP increased (0.81 ± 0.27 to 0.93 ± 0.29, P < 0.001). At 1 year, atrial fibrillation recurrence occurred in 50/118 patients (42%). Restricted cubic spline analysis demonstrated a significant nonlinear association between TAPSE/PASP and AF recurrence (P for nonlinearity = 0.041). Patients in the lowest TAPSE/PASP tertile (<0.67 mm/mmHg) had a higher risk of atrial fibrillation recurrence at 1 year compared with those in the highest (hazard ratio 2.66, 95% confidence interval 1.31-5.45, P = 0.007). Kaplan-Meier analysis confirmed a higher recurrence rate in the lowest tertile (log-rank P = 0.012). CONCLUSION: In patients undergoing catheter ablation for atrial fibrillation, RV-PA coupling significantly improved after the procedure. Lower baseline TAPSE/PASP was independently associated with atrial fibrillation recurrence, supporting the role of RV-PA uncoupling as a potential marker for postablation risk stratification.