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Blunted rate-dependent left atrial pressure response during isoproterenol infusion in atrial fibrillation patients with impaired left ventricular diastolic function: a comparison to pacing

 Tae-Hoon Kim  ;  Jihei Sara Lee  ;  Junbeom Park  ;  Jin-Kyu Park  ;  Jae-Sun Uhm  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Hui-Nam Pak 
 EUROPACE, Vol.17(suppl_2) : ii89-ii96, 2015 
Journal Title
Issue Date
Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/therapy* ; Atrial Pressure/drug effects* ; Cardiac Pacing, Artificial* ; Cardiotonic Agents/administration & dosage ; Catheter Ablation* ; Combined Modality Therapy ; Female ; Humans ; Infusions, Intravenous ; Isoproterenol/administration & dosage* ; Male ; Middle Aged ; Treatment Outcome ; Ventricular Dysfunction, Left/complications ; Ventricular Dysfunction, Left/diagnosis ; Ventricular Dysfunction, Left/therapy*
Atrial fibrillation ; Diastolic function ; Heart rate ; Isoproterenol ; Left atrial pressure
AIMS: A heart rate (HR)-dependent haemodynamic linkage between peak left atrial (LA) pressure during sinus rhythm (LAPpeak) and estimated left ventricular (LV) filling pressure (E/Em) has not yet been explored. We hypothesized that rate-dependent LAPpeak response differs depending on E/Em in patients with atrial fibrillation (AF).

METHODS AND RESULTS: A total of 331 patients (68.0% male, 59.8 ± 10.8 years old) undergoing radiofrequency catheter ablation (RFCA) for AF were included, and their LAPpeak in sinus rhythm was recorded at the beginning of the procedure and at the HRs of 90, 100, 110, and 120 b.p.m. during right atrial pacing and isoproterenol (ISO-stress) infusion. We compared LAPpeak changes between patients with E/Em ≥ 15 (n = 58) and those with <15 (n = 273). (i) The patterns of pacing rate-dependent LAPpeak increase were similar in both the E/Em < 15 (P < 0.001) and E/Em ≥ 15 groups (P = 0.002). (ii) The ISO-stress reduced LAPpeak in patients with E/Em < 15 (P = 0.015), but not in those with E/Em ≥ 15 (P = 0.582). (iii) Paradoxical ISO-stress LAP elevation in patients with E/Em ≥ 15 was independently associated with 1-year follow-up E/Em reduction (B = -4.07, 95% CI -5.41 to -2.72, P < 0.001). Coexistence of E/Em ≥ 15 and ISO-stress LAP elevation increased specificity in predicting 1-year follow-up E/Em reduction after AF ablation than E/Em alone.

CONCLUSION: Isoproterenol LAPpeak reduction was blunted in patients with impaired LV diastolic function estimated by E/Em ≥ 15. The improvement of LV diastolic dysfunction 1 year after AF ablation was independently associated with both paradoxical ISO-stress LAP elevation and E/Em ≥ 15 at the time of procedure.

Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Park, Jun Beom(박준범)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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