title: Pulmonary vein antrum isolation leads to a significant decrease of left atrial size.
abstract: OBJECTIVE
  Pulmonary vein antrum isolation (PVAI) is an effective treatment for atrial fibrillation (AF); however, its impact on left atrial (LA) size is unknown. This study evaluates the impact of PVAI on LA size, and whether LA size differs between patients with a successful outcome and patients with AF recurrences.
  
  
  RESULTS
  Seventy-nine patients (76% male, mean age 56 ± 8 years) with symptomatic, drug refractory AF (70% paroxysmal, 30% persistent/permanent) underwent radiofrequency PVAI. Ablation lesions were created encircling right and left pulmonary venous ostia in pairs. The endpoint was complete isolation of all pulmonary veins. Magnetic resonance imaging was performed before and 4 months after PVAI and LA volume was measured by manually tracing the LA area. Clinical follow-up was at 1, 3, 6, 12, and 24 months. Rhythm status was determined by history, electrocardiogram, and 48 h Holter monitoring. After a mean follow-up of 12 ± 5 months, 62 patients (78%) were free of AF (72% without antiarrhythmic drugs). In the total group, LA volume decreased from 104 ± 27 mL to 91 ± 25 mL, P < 0.001. Patients with a successful outcome showed a decrease in LA volume of 103 ± 27 mL to 89 ± 24 mL, P < 0.001. Among patients with AF recurrences, LA volume decreased from 105 ± 29 mL to 95 ± 27 mL, P = 0.012. No significant difference was seen between the change in LA volume in both subgroups, P = 0.27.
  
  
  CONCLUSIONS
  Pulmonary vein antrum isolation in patients with AF resulted in a significant decrease of LA size. There was no relation between the decrease in LA size and the recurrence of AF after PVAI.
authors.affiliation: Division of Heart and Lungs, Department of Cardiology, E03.511, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. p.loh@umcutrecht.nl
authors.forename: Irene E
authors.initials: IE
authors.lastname: Hof
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Sevasti-Maria
authors.initials: SM
authors.lastname: Chaldoupi
authors.forename: Fred H
authors.initials: FH
authors.lastname: Wittkampf
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: van Driel
authors.forename: Jeroen F
authors.initials: JF
authors.lastname: van der Heijden
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Cramer
authors.forename: Mathias
authors.initials: M
authors.lastname: Meine
authors.forename: Richard N
authors.initials: RN
authors.lastname: Hauer
authors.forename: Peter
authors.initials: P
authors.lastname: Loh
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome