Skip to main content
SpringerLink
Log in

Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Several studies have demonstrated that left ventricular diastolic dysfunction (LVDD) and left atrial pressure (LAP), as a surrogate marker of LVDD, were associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) for AF. In this study, we aimed to investigate the individual impact of several left ventricular diastolic function parameters on outcomes of cryoablation for paroxysmal AF using second-generation cryoballoon.

Methods

One hundred seventy patients who were scheduled for cryoablation with second-generation cryoballoon were included in this prospective study. All patients underwent comprehensive transthoracic and transesophageal echocardiographic examinations during sinus rhythm a day before catheter ablation. LAP was measured via transseptal sheath at the beginning of the ablation procedure.

Results

One hundred seventy patients (57.09 ± 11.80 years, 47.06 % male) were involved in the study. At a median follow-up of 19 months, when blanking period of 3 months was considered, freedom from AF after a single ablation procedure was 84.71 %. Patients with AF recurrence had significantly greater left atrial volume index (LAVI) (p = 0.005) and LAP (p < 0.001). Patients with AF recurrence had lower septal eʹ wave (p = 0.013), and higher E/eʹ ratio (p = 0.014). LAVI (p = 0.007) and LAP (p = 0.006) were independent predictors of AF recurrence. A cut-off value of 13.50 mmHg for LAP measured during the procedure was associated with a sensitivity and specificity of 80.8 and 84.7 % (p = 0.005) for predicting AF recurrence.

Conclusions

Pre-procedural LAVI and procedural LAP measurement have clinical importance in predicting AF recurrence in patients undergoing cryoablation with second-generation cryoballoon. Effectiveness of cryoablation is reduced in patients with greater LAVI and LAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jais, P., Peng, J. T., Shah, D. C., Garrigue, S., Hocini, M., Yamane, T., et al. (2000). Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. Journal of Cardiovascular Electrophysiology, 11(6), 623–625.

    Article  CAS  PubMed  Google Scholar 

  2. Tsang, T. S., Gersh, B. J., Appleton, C. P., Tajik, A. J., Barnes, M. E., Bailey, K. R., et al. (2002). Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. Journal of the American College of Cardiology, 40(9), 1636–1644.

    Article  PubMed  Google Scholar 

  3. Kosiuk, J., Breithardt, O. A., Bode, K., Kornej, J., Arya, A., Piorkowski, C., et al. (2014). The predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction on short- and long-term outcomes of catheter ablation of atrial fibrillation. Europace, 16(8), 1168–1174.

    Article  PubMed  Google Scholar 

  4. Cha, Y. M., Wokhlu, A., Asirvatham, S. J., Shen, W. K., Friedman, P. A., Munger, T. M., et al. (2011). Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function. Circulation. Arrhythmia and Electrophysiology, 4(5), 724–732.

    Article  PubMed  Google Scholar 

  5. Pezawas, T., Binder, T., Ristl, R., Schneider, B., Stojkovic, S., Schukro, C., et al. (2015). Selection for atrial fibrillation ablation: importance of diastolic function grading. Journal of Cardiology, 65(6), 479–486.

    Article  PubMed  Google Scholar 

  6. Ejima, K., Shoda, M., Arai, K., Suzuki, A., Yagishita, D., Yagishita, Y., et al. (2013). Impact of diastolic dysfunction on the outcome of catheter ablation in patients with atrial fibrillation. International Journal of Cardiology, 164(1), 88–93.

    Article  PubMed  Google Scholar 

  7. Hirai, T., Cotseones, G., Makki, N., Agrawal, A., Wilber, D. J., & Barron, J. T. (2014). Usefulness of left ventricular diastolic function to predict recurrence of atrial fibrillation in patients with preserved left ventricular systolic function. American Journal of Cardiology, 114(1), 65–69.

    Article  PubMed  Google Scholar 

  8. Linhart, M., Lewalter, T., Mittmann-Braun, E. L., Karbach, N. C., Andrie, R. P., Hammerstingl, C., et al. (2013). Left atrial pressure as predictor for recurrence of atrial fibrillation after pulmonary vein isolation. Journal of Interventional Cardiac Electrophysiology, 38(2), 107–114.

    Article  PubMed  Google Scholar 

  9. Bergau, L., Vollmann, D., Luthje, L., Sohns, J. M., Seegers, J., Sohns, C., et al. (2014). Measurement of left atrial pressure is a good predictor of freedom from atrial fibrillation. Indian Pacing Electrophysiol Journal, 14(4), 181–193.

    Article  Google Scholar 

  10. Park, J., Joung, B., Uhm, J. S., Young Shim, C., Hwang, C., Hyoung Lee, M., et al. (2014). High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. Heart Rhythm, 11(6), 953–960.

    Article  PubMed  Google Scholar 

  11. Aytemir, K., Gurses, K. M., Yalcin, M. U., Kocyigit, D., Dural, M., Evranos, B., et al. (2015). Safety and efficacy outcomes in patients undergoing pulmonary vein isolation with second-generation cryoballoon. Europace, 17(3), 379–387.

    Article  PubMed  Google Scholar 

  12. Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2005). Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18(12), 1440–1463.

    Article  PubMed  Google Scholar 

  13. Arya, A., Hindricks, G., Sommer, P., Huo, Y., Bollmann, A., Gaspar, T., et al. (2010). Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace, 12(2), 173–180.

    Article  PubMed  Google Scholar 

  14. Gurses, K. M., Yalcin, M. U., Kocyigit, D., Evranos, B., Ates, A. H., Yorgun, H., et al. (2015). Red blood cell distribution width predicts outcome of cryoballoon-based atrial fibrillation ablation. Journal of Interventional Cardiac Electrophysiology, 42(1), 51–58.

    Article  PubMed  Google Scholar 

  15. Shi, Y., Ducharme, A., Li, D., Gaspo, R., Nattel, S., & Tardif, J. C. (2001). Remodeling of atrial dimensions and emptying function in canine models of atrial fibrillation. Cardiovascular Research, 52(2), 217–225.

    Article  CAS  PubMed  Google Scholar 

  16. De Jong, A. M., Maass, A. H., Oberdorf-Maass, S. U., Van Veldhuisen, D. J., Van Gilst, W. H., & Van Gelder, I. C. (2011). Mechanisms of atrial structural changes caused by stretch occurring before and during early atrial fibrillation. Cardiovascular Research, 89(4), 754–765.

    Article  PubMed  Google Scholar 

  17. Kalifa, J., Jalife, J., Zaitsev, A. V., Bagwe, S., Warren, M., Moreno, J., et al. (2003). Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation. Circulation, 108(6), 668–671.

    Article  PubMed  Google Scholar 

  18. Kanda, T., Masuda, M., Sunaga, A., Fujita, M., Iida, O., Okamoto, S., et al. (2015). Low left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation of persistent atrial fibrillation. Journal of Cardiology, 66(5), 377–381.

    Article  PubMed  Google Scholar 

  19. Fukushima, K., Fukushima, N., Ejima, K., Kato, K., Sato, Y., Uematsu, S., et al. (2015). Left atrial appendage flow velocity and time from P-wave onset to tissue doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation. Echocardiography, 32(7), 1101–1108.

    Article  PubMed  Google Scholar 

  20. Combes, S., Jacob, S., Combes, N., Karam, N., Chaumeil, A., Guy-Moyat, B., et al. (2013). Predicting favourable outcomes in the setting of radiofrequency catheter ablation of long-standing persistent atrial fibrillation: a pilot study assessing the value of left atrial appendage peak flow velocity. Archives of Cardiovascular Diseases, 106(1), 36–43.

    Article  PubMed  Google Scholar 

  21. Agmon, Y., Khandheria, B. K., Meissner, I., Petterson, T. M., O'Fallon, W. M., Wiebers, D. O., et al. (2002). Are left atrial appendage flow velocities adequate surrogates of global left atrial function? A population-based transthoracic and transesophageal echocardiographic study. Journal of the American Society of Echocardiography, 15(5), 433–440.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey

    Banu Evranos, Duygu Kocyigit, Mehmet Levent Sahiner, Ergun Baris Kaya, Necla Ozer & Kudret Aytemir

  2. Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey

    Kadri Murat Gurses

  3. Department of Cardiology, Hakkari State Hospital, Hakkari, Turkey

    Muhammed Ulvi Yalcin

Authors
  1. Banu Evranos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Duygu Kocyigit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kadri Murat Gurses
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muhammed Ulvi Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Levent Sahiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ergun Baris Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Necla Ozer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kudret Aytemir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Banu Evranos.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Funding

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Evranos, B., Kocyigit, D., Gurses, K.M. et al. Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon. J Interv Card Electrophysiol 46, 145–151 (2016). https://doi.org/10.1007/s10840-016-0107-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0107-8

Keywords

Search

Navigation