title: Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: an evaluation using magnetic resonance angiography.
abstract: BACKGROUND
  Catheter ablation to achieve pulmonary vein (PV) isolation has become an increasingly used treatment strategy for patients with atrial fibrillation (AF). The purpose of this study was to evaluate the impact of segmental isolation of PVs on volume of left atrium and its relation to the decrease in the size of the pulmonary veins.
  
  
  METHODS
  Gadolinium enhanced Magnetic Resonance Angiography (MRA) was performed in 51 AF patients before and 6 approximately 8 weeks post PV isolation, using cooled radio-frequency (RF) energy. Three-dimensional reconstruction with maximum intensity projections and multiplanar reformations was performed. Oblique coronal projections were used to measure the ostial size of PVs. Three orthogonal dimensions of LA chamber were measured and computed to assess the volume of the left atrium.
  
  
  RESULTS
  The mean LA volume decreased by 15.7% after ablation (p<0.001). The mean PV ostial diameter decreased by 11%, from 18.3+/-0.8 mm to 16.7+/-1.0 mm (p=0.005). Moderate PV stenosis was noted in two veins out of the 192 veins analyzed. There was a significant correlation between changes in the size of PV ostium to that of the LA.
  
  
  CONCLUSIONS
  Catheter ablation of AF using a segmental PV isolation approach results in a significant reverse remodeling in the left atrium. Significant stenosis of PVs appears to be rare after the segmental isolation procedure.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0409, USA.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Jayam
authors.forename: Jun
authors.initials: J
authors.lastname: Dong
authors.forename: Chandrasekhar R
authors.initials: CR
authors.lastname: Vasamreddy
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Ritsushi
authors.initials: R
authors.lastname: Kato
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.forename: Zayd
authors.initials: Z
authors.lastname: Eldadah
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: David A
authors.initials: DA
authors.lastname: Blumke
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Henry R
authors.initials: HR
authors.lastname: Halperin
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011667:Pulmonary Veins / Q000473:pathology* / Q000601:surgery; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis*; D016896:Treatment Outcome