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.