Right ventricular-pulmonary artery uncoupling, indicated by a lower TAPSE/PASP ratio, was independently associated with an increased risk of late arrhythmia recurrence after catheter ablation in persistent atrial fibrillation patients (HR 0.12 per 1-unit increase in TAPSE/PASP).
Observational (n=203)
No
Does baseline right ventricular-pulmonary artery uncoupling (TAPSE/PASP ratio) predict late recurrence of atrial fibrillation after catheter ablation in patients with persistent atrial fibrillation?
Right ventricular-pulmonary artery uncoupling (TAPSE/PASP ≤0.57) is an independent predictor of late atrial fibrillation recurrence after catheter ablation in patients with persistent atrial fibrillation.
Effect estimate: HR 0.12 (95% CI 0.019-0.724)
p-value: p=0.026
Background: Right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcomes in heart failure patients. We aimed to elucidate the relationship between RV-PA uncoupling and late arrhythmia recurrence after ablation in persistent atrial fibrillation (PerAF) patients whose phenotypes have impaired right ventricular function and pulmonary hypertension. Methods: The present study included 203 PerAF patients from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who underwent an initial ablation. We assigned the patients based on the value of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio that could predict late recurrence of AF/atrial tachycardia (LRAF) as an indicator of RV-PA uncoupling. We evaluated the following factors: the difference in the relationship between TASPE/PASP before ablation and incidence of LRAF among the 2 groups stratified by TAPSE/PASP based on the above cut-off value and TAPSE/PASP change from before to one-year after ablation. Results: A receiver operating characteristic curve analysis revealed a good accuracy of predicting LRAF by TAPSE/PASP ratio with a cutoff of 0.57. The patients with TAPSE/PASP ratios ≤ 0.57 had a significantly greater LRAF risk than TAPSE/PASP ratios > 0.57. A multivariate Cox proportional hazards analysis showed that TAPSE/PASP (HR 0.12, 95% CI; 0.019-0.724, p = 0.026) was independently and significantly associated with LRAF. The TAPSE/PASP significantly improved more one-year after the ablation than before (p = 0.016). Conclusion: RV-PA uncoupling was independently associated with LRAF, independent of left atrial function, and significantly improved more one-year after the ablation than before in PerAF patients.
Yano et al. (Sat,) conducted a observational in Persistent atrial fibrillation (n=203). Right ventricular-pulmonary artery uncoupling (TAPSE/PASP ratio ≤ 0.57) vs. TAPSE/PASP ratio > 0.57 was evaluated on Late recurrence of atrial fibrillation/atrial tachycardia (LRAF) (HR 0.12, 95% CI 0.019-0.724, p=0.026). Right ventricular-pulmonary artery uncoupling, indicated by a lower TAPSE/PASP ratio, was independently associated with an increased risk of late arrhythmia recurrence after catheter ablation in persistent atrial fibrillation patients (HR 0.12 per 1-unit increase in TAPSE/PASP).