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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

Title
Blunted rate-dependent left atrial pressure response during isoproterenol infusion in atrial fibrillation patients with impaired left ventricular diastolic function: a comparison to pacing
Author
박진규
Keywords
Atrial fibrillation; Left atrial pressure; Heart rate; Diastolic function; Isoproterenol
Issue Date
2015-10
Publisher
OXFORD UNIV PRESS
Citation
EUROPACE, v. 17, Page. 89-96
Abstract
Aims A heart rate (HR)-dependent haemodynamic linkage between peak left atrial (LA) pressure during sinus rhythm (LAP(peak)) and estimated left ventricular (LV) filling pressure (E/Em) has not yet been explored. We hypothesized that rate-dependent LAP(peak) 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 LAP(peak) 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 LAP(peak) changes between patients with E/Em ˃= 15 (n = 58) and those with ˂15 (n = 273). (i) The patterns of pacing rate-dependent LAP(peak) 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 LAP(peak) 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 LAP(peak) 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.
URI
https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/euv239http://hdl.handle.net/20.500.11754/28158
ISSN
1099-5129; 1532-2092
DOI
10.1093/europace/euv239
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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