The effect of different treatment strategies on left atrial size in patients with lone paroxysmal atrial fibrillation-a prospective cohort study.
BACKGROUND
The effect of different treatment strategies of atrial fibrillation on left atrial (LA) size has not been compared in lone paroxysmal atrial fibrillation. The objective of the present study was to evaluate the evolution of LA size over time in patients who underwent different treatment interventions.


RESULTS
Two hundred forty patients with lone paroxysmal atrial fibrillation were assigned to four groups. The circumferential pulmonary vein ablation (CPVA) group (n = 60) was treated with CPVA, segmental pulmonary vein isolation (SPVI) group (n = 60) with SPVI, AMIO group (n = 60) with amiodarone alone, and AMIO + LO group (n = 60) with amiodarone plus losartan. LA diameter was measured with transthoracic echocardiogram at baseline, 3, 6, 9, and 12 months after the interventions. In the CPVA group, LA size at third, sixth, ninth, and 12th month had a significant decrease than that at baseline and in the other three groups. LA size in patients with atrial fibrillation recurrence in the four groups was significant higher than that in patients with no atrial fibrillation recurrence (P = 0.002-0.001).


CONCLUSIONS
The results suggested that a shortened LA size is not consistent with improved sinus rhythm maintenance. Although maintenance of sinus rhythm is not the only factor in determining shrinking or enlargement of the left atrium, inhibiting or eliminating activity of the pulmonary vein is very important for paroxysmal atrial fibrillation. Atrial fibrillation recurrence is a main factor contributing to enlargement of the LA.
Liu
Zengzhang
Z
Department of Cardiology, The 2nd Affiliated Hospital, Chongqing University of Medical Sciences, China.
Ling
Zhiyu
Z
Su
Li
L
Wu
Jinjin
J
Lan
Xianbin
X
Chen
Yunqing
Y
Du
Huaan
H
She
Qiang
Q
Yin
Yuehui
Y
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D019808:Losartan; D000638:Amiodarone