Atrial volume reduction following catheter ablation of atrial fibrillation and relation to reduction in pulmonary vein size: an evaluation using magnetic resonance angiography.
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.
Jayam
Vinod K
VK
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0409, USA.
Dong
Jun
J
Vasamreddy
Chandrasekhar R
CR
Lickfett
Lars
L
Kato
Ritsushi
R
Dickfeld
Timm
T
Eldadah
Zayd
Z
Dalal
Darshan
D
Blumke
David A
DA
Berger
Ronald
R
Halperin
Henry R
HR
Calkins
Hugh
H
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