Waanders, M.D. (2019) ‘Maximum Left Atrial Pressure at Baseline is a Strong Predictor of Recurrent Atrial Fibrillation after Pulmonary Vein Isolation and is Superior to Pacing Induced Left Atrial Pressure Increase’. thesis, Medicine.
Full text available on request.Abstract
Background: baseline and exercise induced left atrial pressure (LAP) have been demonstrated to predict recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI). The role of pacing-induced LAP alterations in predicting recurrence of AF has not yet been elucidated. Purpose: in a prospective study, we investigated the role of pacing induced LAP changes for predicting recurrence of AF after PVI. Methods: 122 AF patients were included (88 male, age: 61±9 years, 95% paroxysmal AF) who underwent primary PVI. LAP was measured invasively during PVI procedure at baseline and during incremental atrial pacing. Measurements of LAP were analyzed together with clinical and imaging data. Results: 39 (32%) patients had recurrence of AF during 12 months follow-up after PVI. Patients with recurrence of AF had a higher maximum LAP at baseline (p=0.011), higher left atrial volume index (LAVI) (p=0.014) and higher NT-proBNP (p=0.014). Mixed models analyses showed a significant increase in LAP during incremental pacing (P<0,01); however, this increase did not differ significantly between patients with and without recurrence of AF after PVI. In a multivariate Cox regression analysis maximum baseline LAP (hazard ratio (HR):1.11, confidence interval (CI):1.03-1.16, p=0.002) and LAVI (HR:1.03, CI:1.01-1.06, p=0.020) were independent predictors of AF recurrence. Baseline maximum LAP>21.5 mmHg predicted AF recurrence with a sensitivity and specificity of respectively 0.64 and 0.71 and was associated with a HR of 2.7 (CI: 1.4-5.2). Conclusion: maximum baseline LAP and LAVI are independent predictors of AF recurrence after PVI. Pacing induced LAP increase does not predict the outcome of PVI.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Elvan, A. M.D., Ph. D. |
| Supervisor name: | Manfai, B. M.D. and Ramjan, T.T.T.K. M.D. Ph. D. |
| Faculty: | Medical Sciences |
| Date Deposited: | 02 Oct 2020 12:38 |
| Last Modified: | 02 Oct 2020 12:38 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2772 |
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