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Raul Valerio; Rafael  Thiesen Magliari; Alfredo  Augusto Eyer Rodrigues; Cristiano  de Oliveira Dietrich

Authors

Raul Valerio DASA – São Paulo (SP), Brazil. https://orcid.org/0000-0003-1530-3795
Rafael Thiesen Magliari Hospital do Coração – São Paulo (SP), Brazil. https://orcid.org/0000-0002-3839-6253
Alfredo Augusto Eyer Rodrigues DASA – São Paulo (SP), Brazil / Universidade Federal de São Paulo – São Paulo (SP), Brazil.
Cristiano de Oliveira Dietrich Hospital do Coração – São Paulo (SP), Brazil / Universidade Federal de São Paulo – São Paulo (SP), Brazil.

Keywords:

Atrial fibrillation, Catheter ablation, Stiff left atrium, Magnetic resonance imaging

Abstract

Atrial fibrillation is the most prevalent arrhythmia in clinical practice and has different strategies for its control. Of these strategies, the percutaneous ablation of the pulmonary veins stands out, with robust results in relation to drug treatment. It is an invasive procedure and, therefore, not free from complications, which must be properly diagnosed and treated. Among the possible complications, there is stiff atrium syndrome, characterized by reduced atrial compliance caused by post-ablation fibrosis, which, in turn, leads to atrial filling dysfunction and the consequent increase in atrial and venous capillary pulmonary pressures. The case report demonstrates this infrequent but important complication, which presents good results for clinical treatment, in addition to the contribution of cardiac magnetic resonance in its diagnosis and in the assessment of arrhythmia recurrence rates.

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References

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612

Gibson DN, Di Biase L, Mohanty P, Patel JD, Bai R, Sanchez J, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: Clinical characterization, prevalence, and predictors. Hear Rhythm. 2011;8(9):1364-71. http://dx.doi.org/10.1016/j.hrthm.2011.02.026

Yang Y, Liu Q, Wu Z, Li X, Xiao Y, Tu T, et al. Stiff left atrial syndrome: a complication undergoing radiofrequency catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2016;27(7):884-9. https://doi.org/10.1111/jce.12966

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Hear Rhythm. 2017;14(10):e275-e444. http://dx.doi.org/10.1016/j.hrthm.2017.05.012

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythmia. 2017;33(5):369-409. https://doi.org/10.1016/j.joa.2017.08.001

Gibson DN, Di Biase L, Mohanty P, Patel JD, Bai R, Sanchez J, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: Clinical characterization, prevalence, and predictors. Heart Rhythm. 2011;8(9):1364-71. https://doi.org/10.1016/j.hrthm.2011.02.026

Urey MA, Darden D, Stoller D, Drazner MH, Horn V, Sarma S, et al. Stiff Left atrial syndrome after multiple percutaneous catheter ablations: role for invasive hemodynamic exercise testing. Circ Hear Fail. 2017;10(5):e003885. https://doi.org/10.1161/circheartfailure.117.003885

Correia ET de O, Barbetta LMDS, da Silva OMP, Mesquita ET. Left atrial stiffness: A predictor of atrial fibrillation recurrence after radiofrequency catheter ablation-a systematic review and meta-analysis. Arq Bras Cardiol. 2019;112(5):501-8. https://doi.org/10.5935/abc.20190040

Park J, Joung B, Uhm JS, Shim CY, Hwang C, Hyoung Lee M, et al. High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. Heart Rhythm. 2014;11(6):953-60. https://doi.org/10.1016/j.hrthm.2014.03.009

Gutterres DB, Derossi DA, Freitas JF, Peçanha LSP, Pimentel RC. Síndrome do átrio esquerdo rígido pós-ablação percutânea por catéter: relato de caso. 2018;97(6):589-93. https://doi.org/10.11606/issn.1679-9836.v97i6p589-593

Leite-Moreira AF, Oliveira SM, Marino P. Left atrial stiffness and its implications for cardiac function. Future Cardiol. 2007;3(2):175-83. https://doi.org/10.2217/14796678.3.2.175

Wu TC. Left atrial stiffness, a marker of atrial cardiomyopathy, and atrial fibrillation – Relationships and predictors for procedure success after catheter ablation. Arq Bras Cardiol. 2019;112(5):509-10. https://doi.org/10.5935/abc.20190087

Khurram IM, Maqbool F, Berger RD, Marine JE, Spragg DD, Ashikaga H, et al. Association between left atrial stiffness index and atrial fibrillation recurrence in patients undergoing left atrial ablation. Circ Arrhythmia Electrophysiol. 2016;9(3):e003163. https://doi.org/10.1161/circep.115.003163