AI Article Synopsis
- Increased left atrial pressure (LAP) is linked to dyspnea and heart failure with preserved ejection fraction (HFPEF) in patients with atrial fibrillation (AF), and this study aimed to compare LAP between paroxysmal AF (PAF) and persistent AF patients.
- The study involved 1,369 participants who underwent AF catheter ablation, measuring LAP across different heart rates and rhythms, revealing that persistent AF had consistently higher LAP than PAF, especially during faster pacing.
- Findings suggest that PAF patients have lower baseline LAP but show more significant increases during rapid pacing, calling for updated HFPEF assessments and better rhythm control strategies in PAF management.
Article Abstract
Background: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF.
Methods And Results: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. HFPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each HFPEF score subgroup (all <0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, <0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, =0.056) because the LAP-peak significantly increased with heart rate in the group with PAF.
Conclusions: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the HFPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control.
Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646497 | PMC |
| http://dx.doi.org/10.1161/JAHA.124.035246 | DOI Listing |
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