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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Intraprocedural Left Atrial Pressure Elevation and Risk of Heart Failure Events After Atrial Fibrillation Ablation
Yusuke Nakashima1, Hironori Ishiguchi1, Yasuhiro Yoshiga1
1Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine Yamaguchi Japan.
Circulation Reports
|February 11, 2026
Summary
Elevated left atrial pressure (LAP) during atrial fibrillation (AF) ablation increases heart failure hospitalization risk. Monitoring LAP intraprocedurally aids in post-ablation risk stratification for AF patients.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- The clinical significance of left atrial pressure (LAP) elevation during atrial fibrillation (AF) ablation is not fully understood.
- Atrial fibrillation ablation is a common procedure to restore normal heart rhythm.
Purpose of the Study:
- To investigate the association between intraprocedural left atrial pressure (LAP) changes and heart failure (HF) hospitalization after AF ablation.
- To identify predictors of significant LAP increase during AF ablation.
Main Methods:
- Retrospective analysis of 189 patients undergoing their first AF thermal ablation.
- Left atrial pressure (LAP) measured at transseptal sheath insertion and withdrawal.
- Patients categorized into high (≥4 mmHg) and low (<4 mmHg) LAP increase groups.
- Primary endpoint: HF hospitalization within 1 year; secondary endpoint: predictors of high LAP increase.
Main Results:
- A median intraprocedural LAP increase of 4 mmHg was observed.
- The high LAP increase group showed a significantly higher cumulative incidence of HF hospitalization (8.5% vs. 1.1%, P=0.020).
- Independent predictors of high LAP increase included female sex, persistent AF, higher BMI, higher initial RAP/LAP ratio, and structural heart disease.
Conclusions:
- Intraprocedural left atrial pressure (LAP) elevation during AF ablation is linked to an increased risk of heart failure hospitalization within one year.
- Monitoring LAP at the start and end of ablation offers a practical method for post-procedural risk stratification in AF patients.
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