Impact of pulmonary hypertension on atrial fibrillation recurrence after pulmonary vein isolation: A prospective multicenter registry study

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Introduction: Pulmonary hypertension (PH) is associated with an increased risk of atrial fibrillation (AF), and AF onset in PH may signal advanced disease. While catheter ablation (CA) offers clinical benefits, post-ablation recurrence remains a challenge. We evaluated whether systolic pulmonary artery pressure (sPAP) predicts AF recurrence following pulmonary vein isolation (PVI). Methods: Data from the prospective, multicenter Israeli Catheter Ablation Registry (ICAR) included 485 patients undergoing PVI between January 2019 and December 2021, all with echocardiographic sPAP measurements. Patients were stratified into two groups based on sPAP values: high-probability PH (sPAP > 45 mmHg) and low/intermediate probability PH (sPAP ≤ 45 mmHg). AF recurrence within 12 months was assessed, along with subgroup analyses and evaluation of procedural complications. Results: Patients with high-probability PH were older (69.05 ± 8.75 vs. 64.34 ± 11.27 years; p < 0.01) and had more comorbidities. Cryoballoon ablation was utilized in 387 patients (79.8%). High-probability PH patients had significantly higher 12-month AF recurrence rates (30.4% vs. 17.2%; p = 0.029), despite similar acute procedural success and overall periprocedural complication rates. A Cox proportional hazards model identified sPAP > 45 mmHg as an independent predictor of recurrence (adjusted HR 2.55; p < 0.01), while spline analysis demonstrated a dose-dependent relationship between rising sPAP values and recurrence. Conclusion: This study emphasizes the importance of PH, evaluated through echocardiographic sPAP values, in predicting post-PVI AF recurrence. These findings support incorporating echocardiographic sPAP into pre-procedural risk assessment to guide customized post-ablation monitoring.

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