Right Ventricular-Pulmonary Artery Coupling in Patients With Atrial Fibrillation and Changes After Catheter Ablation

Atrial fibrillation (AF) is a predominant risk factor for heart failure, even in patients with preserved left ventricular ejection fraction. Emerging evidence suggests the significance of right ventricular-pulmonary artery (RV-PA) uncoupling in heart failure occurrence. We aimed to elucidate the prevalence and associated factors of RV-PA uncoupling and the efficacy of catheter ablation (CA) for RV-PA adaptation in patients with AF without history of heart failure.

We studied 164 patients with AF free of heart failure who had normal left ventricular ejection fraction and underwent first CA. Echocardiography was performed before and 6 months after CA. RV-PA coupling was calculated from the ratio of tricuspid annular plane systolic excursion to PA systolic pressure. Abnormal RV-PA coupling was defined as tricuspid annular plane systolic excursion/PA systolic pressure <0.70 mm/mm Hg.

Among the participants, 32 (19.5%) patients were classified as having abnormal RV-PA coupling. The abnormal RV-PA coupling group was older, and had higher prevalence of persistent AF, higher CRP (C-reactive protein) and B-type natriuretic peptide levels than the normal RV-PA coupling group. Multivariable analysis demonstrated that an elevated CRP level was significantly associated with RV-PA uncoupling (P=0.004). At 6 months after CA, tricuspid annular plane systolic excursion/PA systolic pressure was significantly improved but was still lower in the abnormal RV-PA coupling group than in the normal RV-PA coupling group (P=0.047). Furthermore, improvement of tricuspid annular plane systolic excursion/PA systolic pressure after CA was observed only in patients without recurrent AF.

Approximately 20% of patients with AF with preserved left ventricular ejection fraction had abnormal RV-PA coupling, and CA improved RV-PA coupling status, whereas its benefits were observed in patients free from recurrent AF.