Left atrial contractility is preserved after successful circumferential pulmonary vein ablation in patients with atrial fibrillation.
BACKGROUND
Circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF) consists of creating extensive lesions in the left atrium (LA). The aim of the study was to evaluate changes in LA contractility after ablation and their relationship with procedure outcome.


RESULTS
A series of 90 consecutive patients underwent cardiac magnetic resonance imaging (MRI) before and 4-6 months after CPVA. Only patients in sinus rhythm during both imaging acquisitions were included in the study to measure LA end-diastolic (LAmax) and LA end-systolic (LAmin) volumes. Fifty-five patients were finally analyzed (41 men, 52 +/- 11 years, 74% paroxysmal AF). During a mean follow-up of 12 +/- 7 months and after 1.2 +/- 0.3 ablation procedures, 38 patients (69%) were arrhythmia-free (group I), and the remaining 17 patients had recurrences (group II). There was a significant decrease in mean LAmax volume in both groups, whereas mean LAmin volume only decreased in group I. Mean LA ejection fraction (EF) was preserved after CPVA in group I (40 +/- 11% vs 38 +/- 10%; P = 0.27) but decreased in patients with arrhythmia recurrences (37 +/- 10% vs 27 +/- 10%; P < 0.001). In fact, LA EF remained stable or increased in 68% of patients without arrhythmia recurrences.


CONCLUSIONS
LAmax volume reduction following CPVA occurs regardless of the clinical efficacy of the procedure, whereas mean LAmin volume only decreased in patients without recurrences. LA EF was preserved or even increased in most patients with successful CPVA.
Perea
Rosario J
RJ
Arrhythmia Section, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Tamborero
David
D
Mont
Lluis
L
De Caralt
Teresa M
TM
Ortiz
Jose T
JT
Berruezo
Antonio
A
Matiello
Maria
M
Sitges
Marta
M
Vidal
Barbara
B
Sanchez
Marcelo
M
Brugada
Josep
J
D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D016279:Atrial Function, Left; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome