title: Impact of pulmonary vein antrum isolation on left atrial size and function in patients with atrial fibrillation.
abstract: OBJECTIVE
  The success of PVAI in eliminating AF has been proven; however, its impact on the LA remains uncertain. This study aimed to determine the impact of pulmonary vein antrum isolation (PVAI) on left atrial (LA) size and function in patients with atrial fibrillation (AF).
  
  
  METHODS
  Consecutive patients with AF were included (n = 206). Magnetic resonance imaging (MRI) was performed before and after PVAI in all patients. A subgroup (n = 52) underwent delayed enhancement MRI. Maximal LA volume (LAVmax) and minimal LA volume (LAVmin) were assessed by Simpson's rule. LA function was determined by calculating LA ejection fraction (LA EF). LA fibrosis was manually encircled and summed in the region of interest.
  
  
  RESULTS
  Single procedure success rate was 64 %. LAVmax decreased post-ablation in all patients (125.1 to 111.9 ml, p < 0.001). LAVmin only decreased in patients with a successful outcome post-ablation (65.6 to 58.8 ml, p < 0.001). As a result, LA EF only showed a marked reduction in patients with AF recurrences (42.7 % to 37.9 %, p < 0.001). Post-ablation LA fibrosis could be visualized in 77 % of patients who underwent delayed enhancement MRI (mean amount 1.4 cm(3)). LA fibrosis showed no correlation with the decrease in LAVmax or LA EF.
  
  
  CONCLUSIONS
  PVAI resulted in a reduction of LAVmax in all patients, indicating an effect of ablation induced fibrosis. LAVmin only decreased in patients with a successful outcome, indicating an effect of reverse atrial remodeling. As a result, LA function post-ablation was preserved in patients with a successful outcome and decreased in patients with AF recurrence.
authors: Department of Cardiology, E03.511, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors: Irene E
authors: IE
authors: Hof
authors: Evert-Jan
authors: EJ
authors: Vonken
authors: Birgitta K
authors: BK
authors: Velthuis
authors: Fred H
authors: FH
authors: Wittkampf
authors: Jeroen F
authors: JF
authors: van der Heijden
authors: Kars G
authors: KG
authors: Neven
authors: Wil
authors: W
authors: Kassenberg
authors: Mathias
authors: M
authors: Meine
authors: Maarten J
authors: MJ
authors: Cramer
authors: Richard N
authors: RN
authors: Hauer
authors: Peter
authors: P
authors: Loh
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011667:Pulmonary Veins / Q000601:surgery*; D011846:Radio Waves; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol