Stiff left atrial syndrome

Brief Review

In 1988, Pilote L et al [1] described stiff left atrial syndrome in a patient who developed pulmonary edema seven years after mitral valve replacement, with normal prosthetic valve function and having no mitral regurgitation or significant transmitral diastolic gradient. A prominent V was noted in the left atrial tracing at cardiac catheterisation and a stiff left atrium was confirmed at autopsy.
Gibson DN et al [2] prospectively evaluated the development of left atrial diastolic dysfunction with associated pulmonary hypertension after catheter ablation for atrial fibrillation. From a database of about 1400 patients undergoing catheter ablation of atrial fibrillation, they could detect new or worsening pulmonary hypertension with left atrial diastolic abnormalities in 19 (1.4%). By multivariate analysis, pre procedural left atrial size <45mm, mean left atrial pressure, severe left atrial scarring, diabetes mellitus and obstructive sleep apnea were independently associated with the development of pulmonary hypertension after ablation. They noted that the important features of the stiff left atrial syndrome were dyspnea, congestive heart failure, pulmonary hypertension and large V waves on pulmonary capillary wedge or left atrial pressure tracings, in the absence of mitral regurgitation.
Shoemaker MJ et al [3] reported three patients with left atrial hypertension and presenting with unexplained dyspnea up to six years after multiple catheter ablations for atrial fibrillation. Large V waves defined as 7 mm Hg greater than the mean pulmonary wedge pressure were noted in these patients. They also had elevated right ventricular systolic pressures. Both pulmonary wedge pressures and V waves increased significantly with volume challenge. There was no evidence of pulmonary vein stenosis, left ventricular systolic dysfunction or significant mitral valve disease in these patients.
References

  1. Pilote L et al. Stiff left atrial syndrome. Can J Cardiol. 1988 Sep;4(6):255-7.
  2. Gibson DN et al [Stiff left atrial syndrome after catheter ablation for atrial fibrillation: Clinical characterization, prevalence, and predictors. Heart Rhythm. 2011 Sep;8(9):1364-71.
  3. Shoemaker MB et al. Left atrial hypertension after repeated catheter ablations for atrial fibrillation. Am Coll Cardiol, 2011; 57:1918-1919.

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