Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: an echocardiography and cine computed tomography analysis.
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.
Verma
Atul
A
Marin General Hospital, Sutter Pacific Heart Centers, San Francisco, California, USA.
Kilicaslan
Fethi
F
Adams
James R
JR
Hao
Steven
S
Beheiry
Salwa
S
Minor
Stephen
S
Ozduran
Volkan
V
Claude Elayi
Samy
S
Martin
David O
DO
Schweikert
Robert A
RA
Saliba
Walid
W
Thomas
James D
JD
Garcia
Mario
M
Klein
Allan
A
Natale
Andrea
A
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