Right ventricular to pulmonary artery coupling change after catheter ablation of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) to pulmonary artery (PA) coupling can be assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP). Although its use has been w...

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Published in:European heart journal cardiovascular imaging 2023-06, Vol.24 (Supplement_1)
Main Authors: Bonelli, A, Degiovanni, A, Cersosimo, A, Spinoni, E G, Bosco, M, Dell'era, G, Patti, G, Adamo, M, Curnis, A, Moreo, A, De Chiara, B C, Gigli, L, Giannattasio, C, Metra, M, Inciardi, R M
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Language:English
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Summary:Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) to pulmonary artery (PA) coupling can be assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP). Although its use has been widely adopted in clinical practice, less is known about its role in patients with atrial fibrillation (AF) and its change after catheter ablation. Purpose The aim of this study is to assess the changes and the clinical impact of RV-PA coupling in patients with AF who underwent catheter ablation. Methods This is a prospective study that enrolled patients undergoing catheter ablation for AF between March 2021 and September 2022 in three tertiary centers in Italy. We evaluated the changes in RV structure and function and TAPSE/PASP between baseline and the 3-month follow-up and their relation with AF relapse after procedure. Results A total of 135 patients were included (mean age 65.2 ± 9.1 years; 68% males, mean left ventricular ejection fraction [LVEF] 56.9 ± 7.9%). Patients in the lowest tertile (TAPSE/PASP < 0.67 mm/mmHg) were older, with and LVEF and LV global longitudinal strain (LVGLS). They also showed lower TAPSE, S’ wave at Tissue Doppler and RV global strain and higher PASP. In the overall population, after 3 months from the ablation procedure, we observed a significant increase of TAPSE (from 22.4 ± 4.1 to 24.0 ± 3.8, p < 0.001), a reduction of PASP (from 29.5 ± 6.6 to 27.9 ± 7.7, p = 0.030) and an increase in TAPSE/PASP from 0.81 ± 0.27 to 0.93 ± 0.29 (p < 0.001). The latter improved both in the patients who were in sinus rhythm (p = 0.031) and with AF (p = 0.003) at baseline. Compared to patients in the highest TAPSE/PASP tertile, those in the lowest one (TAPSE/PASP < 0.67 mm/mmHg) showed an increased risk of AF relapse after catheter ablation (OR 4.33, 95% confidence interval 1.25 – 14.96, p = 0.020). Moreover, the increase of TAPSE/PASP ratio during the follow-up period was associated with a reduced probability of AF relapse, after adjustment for covariates (OR 0.70, 95% confidence interval 0.49 – 0.99, p = 0.046). Conclusion In a multicenter cohort of patients with AF undergoing catheter ablation, a significant improvement of RV-PA coupling, assessed by the TAPSE/PASP ratio, has been observed, regardless of rhythm at admission. Moreover, TAPSE/PASP at baseline, and its change, may represent a useful parameter to predict AF relapse after the procedu
ISSN:2047-2404
2047-2412
DOI:10.1093/ehjci/jead119.236