Association of Mean Left Atrial Pressure With Clinical Characteristics and Outcomes in Patients Undergoing Catheter Ablation for Atrial Fibrillation ― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Background: The association of invasively measured mean left atrial pressure (LAP) during catheter ablation (CA) for atrial fibrillation (AF) with clinical characteristics and outcomes remains unclear. Methods and Results: We analyzed the data of 480 patients from the Shinshu Catheter Ablation Registry who underwent CA for AF (median age, 69 years; 146 women [30.4%]; 207 patients [43.1%] with persistent AF). Patients were categorized by mean LAP as normal (<12 mmHg; n=318 [66.3%]), mildly elevated (12 to <15 mmHg; n=78 [16.3%]), or elevated (≥15 mmHg; n=84 [17.5%]). Study endpoints were early AF recurrence within the 8-week blanking period, late AF recurrence, and composite adverse clinical events (heart failure hospitalization, symptomatic stroke, or all-cause death) during the 1-year follow-up after CA. Patients in the higher LAP groups had a higher prevalence of obesity and persistent AF, and a larger left atrial volume index. Early AF recurrence differed significantly across the LAP groups and was highest in the elevated LAP group (log-rank P=0.017). After multivariable adjustment, early AF recurrence risk increased across the LAP groups (hazard ratio per-category increase, 1.41; 95% confidence interval, 1.04–1.90; P for trend=0.028). In contrast, late AF recurrence and composite adverse clinical events did not differ significantly across the LAP groups. Conclusions: Mean LAP during CA for AF was associated with AF-related clinical characteristics and early AF recurrence.