title: Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: an echocardiography and cine computed tomography analysis.
abstract: BACKGROUND
  Although pulmonary vein antrum isolation (PVAI) may cure atrial fibrillation (AF) and improve left atrial (LA) function, the effect of extensive LA ablation on LA function is not well known.
  
  
  OBJECTIVE
  To assess the impact of PVAI on LA function remotely postablation.
  
  
  METHODS
  Consecutive patients undergoing PVAI had either transthoracic (TTE) and transesophageal (TEE) echocardiography (n = 41) or cine EBCT (n = 26) performed preablation and 6 months postablation. Only patients with paroxysmal and persistent, but not permanent, AF were included. Imaging was done in sinus rhythm for all patients. LA diameter (LAD), LA systolic and diastolic areas, and left atrial fractional area change (LFAC) were assessed by TTE. Transmitral (TMF), left atrial appendage (LAA), and pulmonary venous (PVF) Doppler flows were measured by TEE. Peak A on TMF, LAA peak emptying velocity (LAAF), and peak A reversal (AR) on PVF were used as surrogates of LA contractile function. Peak S on PV flow was used as a surrogate of reservoir function. LA areas, volumes, and LA ejection fraction (LAEF) were measured from cine EBCT.
  
  
  RESULTS
  Mean radiofrequency ablation time was 45 +/- 21 minutes. All four PVs were isolated for all patients; there were no cases of PV stenosis. Echocardiography revealed a significant reduction in LAD and LA areas post-PVAI. Both peak A and peak AR were also higher post, while other variables showed strong trends toward improvement. In the subset of patients with persistent AF, post-PVAI improvements were seen in LA size, peak A, and even peak S (P = 0.04). Cine EBCT showed a significant decrease in both LA areas and volumes post-PVAI. There was also a significant improvement in LAEF post-PVAI from 17 +/- 6% to 22 +/- 5% (P = 0.01).
  
  
  CONCLUSIONS
  Extensive ablation during PVAI does not cause deterioration in LA function, and may cause long-term improvement, especially in patients with higher AF burden.
authors.affiliation: Marin General Hospital, Sutter Pacific Heart Centers, San Francisco, California, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
authors.forename: James R
authors.initials: JR
authors.lastname: Adams
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Stephen
authors.initials: S
authors.lastname: Minor
authors.forename: Volkan
authors.initials: V
authors.lastname: Ozduran
authors.forename: Samy
authors.initials: S
authors.lastname: Claude Elayi
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Mario
authors.initials: M
authors.lastname: Garcia
authors.forename: Allan
authors.initials: A
authors.lastname: Klein
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000379:methods*; D002933:Cineradiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography