The Effect of Open-Irrigated Radiofrequency Catheter Ablation of Atrial Fibrillation on Left Atrial Pressure and B-Type Natriuretic Peptide

Seiler, Jens; Steven, Daniel; Roberts-Thomson, Kurt C; Inada, Keiichi; Tedrow, Usha B; Michaud, Grogory F; Stevenson, William G (2014). The Effect of Open-Irrigated Radiofrequency Catheter Ablation of Atrial Fibrillation on Left Atrial Pressure and B-Type Natriuretic Peptide. PACE - Pacing and clinical electrophysiology, 37(5), pp. 616-623. Wiley-Blackwell 10.1111/pace.12329

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Background Open-irrigated radiofrequency catheter ablation (oiRFA) of atrial fibrillation (AF) imposes a volume load and risk of pulmonary edema. We sought to assess the effect of volume administration during ablation on left atrial (LA) pressure and B-type natriuretic peptide (BNP). Methods LA pressure was measured via transseptal sheath at the beginning and end of 44 LA ablation procedures in 42 patients. BNP plasma levels were measured before and after 10 procedures. Results A median of 3,255 (interquartile range [IQR], 2,014)-mL saline was administered during the procedure. During LA ablation, the median fluid balance was +1,438 (IQR, 1,109) mL and LA pressure increased by median 3.7 (IQR, 5.9) mm Hg (P < 0.001). LA pressure did not change in the 19 procedures with furosemide administration (median ΔP = −0.3 [IQR, 7.1] mm Hg, P = 0.334). The correlation of LA pressure and fluid balance was weak (rs = 0.383, P = 0.021). BNP decreased in all four procedures starting in AF or atrial tachycardia and then converting to sinus rhythm (P = 0.068), and increased in all six procedures starting and finishing in sinus rhythm (P = 0.028). After ablation, symptomatic volume overload responding to diuresis occurred in three patients. Conclusions A substantial intravascular volume load during oiRFA can be absorbed with little change in LA pressure, such that LA pressure is not a reliable indicator of the fluid balance. Subsequent redistribution of the volume load imposes a risk after the procedure. Conversion to sinus rhythm may improve ability to acutely accommodate the volume load.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Seiler, Jens

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0147-8389

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jens Seiler

Date Deposited:

19 Mar 2014 12:06

Last Modified:

02 Nov 2015 09:31

Publisher DOI:

10.1111/pace.12329

PubMed ID:

24372302

Uncontrolled Keywords:

atrial fibrillation, radiofrequency catheter ablation, open irrigation, left atrial pressure, B-type natriuretic peptide

BORIS DOI:

10.7892/boris.42442

URI:

https://boris.unibe.ch/id/eprint/42442

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