Multivariate Analysis
Our multivariate analysis suggests AF recurrence is a risk factor for HF
events post ablation. In fact, the use of a class III antiarrhythmic to
maintain sinus rhythm post-ablation may even be protective against HF.
These patients also had an increased LAP post-ablation but this was not
associated with increased HF events in a multivariate analysis. Kishima
et al previously described elevated LAP is a risk factor for developing
AF post-ablation. (14) We expand upon this and propose that a recurrence
of AF produces lack of atrial contribution to cardiac output, decreases
ventricular filling with tachycardia and disrupts intracellular calcium
handling precipitating HF events. Though cardiac output, heart rate, and
systemic blood pressure measured acutely during the procedure did not
correlate to incident HF, post ablation LAP may uniquely reflect the
ability of the atrium to handle volume in the setting of inflammatory
changes from ablation. Taking steps to prevent AF recurrence
post-ablation may mitigate the adverse pathophysiologic effects of AF
and reduce HF events. Furthermore, the use of a loop diuretic
pre-procedurally may be an indicator of susceptibility to hypervolemic
states such as HF.