Effect of Atrial Fibrillation on Pulmonary Artery Pressures in Ambulatory Heart Failure Patients

Background: Implanted Pulmonary Artery Pressure (PAP) sensor technology is utilized to optimize and individualize heart failure (HF) therapy. Atrial fibrillation (AF) occurs in up to 20% of HF patients indicated for a sensor and is independently associated with risk of adverse outcomes. Objective: To determine if excursions in PAP are associated with onset episodes of paroxysmal AF. Methods: A retrospective review was performed on patients from the University of Southern California who had both a cardiac rhythm management device (CRM) and a PA sensor by reviewing episodes of mode switch stored in the CRM log. Mean PAP on the day of the AF triggered episode +/− one day was compared with baseline PAP, defined as the average of the lowest three PAP values within one month prior to the event. Results: Baseline characteristics are shown in Fig. 1. In 4/5 AF events, mean PAP was significantly higher than baseline PAP (mean 8 mmHg ± 5 mmHg, Fig. 1). In 3/5 events, systolic PAP was significantly higher than baseline systolic PAP (mean 14 mmHg ± 8 mmHg) and diastolic PAP was significantly higher than baseline diastolic PAP (mean 10 mmHg ± 6 mmHg). In 3/5 events, heart rate was significantly higher than baseline heart rate (mean 7 bpm ± 5 bmp). Conclusion: During episodes of paroxysmal AF, mean PAP is significantly elevated compared to baseline PAP. Worsened hemodynamics during AF may account for the additional risk associated with AF in this population and should be further evaluated because more aggressive treatment to prevent AF may be warranted.