The effect of open-irrigated radiofrequency catheter ablation of atrial fibrillation on left atrial pressure and B-type natriuretic peptide
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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, Gregory F; Stevenson, William G.
in: PACE, Jahrgang 37, Nr. 5, 05.2014, S. 616-623.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The effect of open-irrigated radiofrequency catheter ablation of atrial fibrillation on left atrial pressure and B-type natriuretic peptide
AU - Seiler, Jens
AU - Steven, Daniel
AU - Roberts-Thomson, Kurt C
AU - Inada, Keiichi
AU - Tedrow, Usha B
AU - Michaud, Gregory F
AU - Stevenson, William G
N1 - ©2013 Wiley Periodicals, Inc.
PY - 2014/5
Y1 - 2014/5
N2 - 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.
AB - 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.
KW - Atrial Fibrillation/complications
KW - Atrial Pressure
KW - Catheter Ablation/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Natriuretic Peptide, Brain/blood
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Therapeutic Irrigation/adverse effects
KW - Treatment Outcome
KW - Water-Electrolyte Imbalance/diagnosis
U2 - 10.1111/pace.12329
DO - 10.1111/pace.12329
M3 - SCORING: Journal article
C2 - 24372302
VL - 37
SP - 616
EP - 623
JO - PACE
JF - PACE
SN - 0147-8389
IS - 5
ER -