Sinus Rhythm Maintenance After Pulsed-Field Ablation Is Associated With Improved Right Ventricular-Pulmonary Artery...

Atrial fibrillation (AF) is associated with disrupted right ventricular-pulmonary artery (RV-PA) coupling. Pulsed-field ablation (PFA) is less likely to induce an increase in pulmonary arterial pressure; however, changes in RV-PA coupling following AF ablation using PFA remain unclear.

We retrospectively analyzed consecutive patients who underwent AF ablation using PFA. RV-PA coupling was assessed using the echocardiographic tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio before and 3 months after ablation. In all, 103 patients were included in this study: 46 with paroxysmal AF (PAF) and 57 with persistent AF (PeAF), with 41 PeAF patients maintaining sinus rhythm (SR) at 3 months. The TAPSE/PASP ratio improved significantly after AF ablation using PFA in the overall cohort (mean [±SD] 0.794±0.313 vs. 0.906±0.294; P=0.009) and in PeAF patients (0.740±0.343 vs. 0.887±0.282, P=0.01); however, no significant change was observed in PAF patients (P=0.26). PASP did not increase after ablation in any group. Among PeAF patients maintaining SR at 3 months, baseline mean heart rate during AF showed a weak association with changes in the TAPSE/PASP ratio.

AF ablation using PFA was associated with an improvement in RV-PA coupling without an increase in pulmonary arterial pressure, particularly in patients with PeAF in whom SR was maintained at 3 months.