Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins.
OBJECTIVE
The purpose of this study was to determine the effect of left atrial circumferential ablation on the size of the left atrium and pulmonary veins (PVs).


BACKGROUND
The long-term effects of left atrial circumferential ablation on left atrial and PV size and anatomy have not been analyzed in quantitative fashion.


METHODS
PV and left atrial sizes were analyzed in 41 consecutive patients (mean age 54 +/- 12 years) with paroxysmal (n = 25) or chronic (n = 16) atrial fibrillation. Computed tomography of the chest with three-dimensional reconstruction was performed before and 4 +/- 2 months after left atrial circumferential ablation. Left atrial circumferential ablation was performed to encircle the PVs 1 to 2 cm from the ostia, using a power output of 70 W. Additional ablation lines were created in the posterior left atrium and mitral isthmus. Radiofrequency energy also was delivered within the circles and at the PV ostia in 51% of patients at a reduced power output of 35 W.


RESULTS
At 6 months, 36 patients (88%) were in sinus rhythm without antiarrhythmic drug therapy, including 3 patients (7%) who developed persistent left atrial flutter and underwent subsequent successful ablation of atrial flutter. There was a 15 +/- 16% decrease in left atrial volume (P < .01) and 10 +/- 35% decrease in PV ostial area (P < .01), without focal narrowing, in patients with a successful outcome. Focal PV stenosis did not occur in any of the 41 patients.


CONCLUSIONS
Maintenance of sinus rhythm after left atrial circumferential ablation is associated with reduced left atrial and PV ostial size. Left atrial circumferential ablation for atrial fibrillation does not cause PV stenosis.
Lemola
Kristina
K
Division of Cardiology, University of Michigan, Ann Arbor, 48109, USA.
Sneider
Michael
M
Desjardins
Benoit
B
Case
Ian
I
Chugh
Aman
A
Hall
Burr
B
Cheung
Peter
P
Good
Eric
E
Han
Jihn
J
Tamirisa
Kamala
K
Bogun
Frank
F
Pelosi
Frank
F
Kazerooni
Ella
E
Morady
Fred
F
Oral
Hakan
H
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed