Impact of pulmonary vein antrum isolation on left atrial size and function in patients with atrial fibrillation

  • Irene E. Hof
  • Evert-Jan Vonken
  • Birgitta K. Velthuis
  • Fred H. Wittkampf
  • Jeroen F. van der Heijden
  • Kars G. Neven
  • Wil Kassenberg
  • Mathias Meine
  • Maarten J. Cramer
  • Richard N. Hauer
  • Peter Loh



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).


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.


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 cm3). LA fibrosis showed no correlation with the decrease in LAVmax or LA EF.


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.


Atrial fibrillation Left atrium Magnetic resonance imaging Pulmonary vein antrum isolation 



Atrial fibrillation


Delayed enhancement magnetic resonance imaging


Left atrial/left atrium

LA active EF

Active left atrial emptying fraction


Left atrial ejection fraction

LA passive EF

Passive left atrial emptying fraction


Maximal left atrial volume


Mid left atrial volume


Minimal left atrial volume


Magnetic resonance imaging


Pulmonary vein antrum isolation



Dr. Wittkampf is a consultant for St. Jude Medical.


  1. 1.
    Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 3, 32–38.PubMedCrossRefGoogle Scholar
  2. 2.
    Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S. A., Crijns, H. J., et al. (2007). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. Europace, 9, 335–379.PubMedCrossRefGoogle Scholar
  3. 3.
    Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., et al. (2009). Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation. Two systematic literature reviews and meta-analyses. Circulation. Arrhythmia and Electrophysiology, 2, 349–361.PubMedCrossRefGoogle Scholar
  4. 4.
    Jeevanantham, V., Ntim, W., Navaneethan, S. D., Shah, S., Johnson, A. C., Hall, B., et al. (2010). Meta-analysis of the effect of radiofrequency catheter ablation on left atrial size, volumes and function in patients with atrial fibrillation. American Journal of Cardiology, 105, 1317–1326.PubMedCrossRefGoogle Scholar
  5. 5.
    Hof, I. E., & Loh, P. (2011). Left atrial size and function after catheter ablation of atrial fibrillation: comparing apples and oranges. American Journal of Cardiology, 107, 143.PubMedCrossRefGoogle Scholar
  6. 6.
    Hof, I. E., Velthuis, B. K., Van Driel, V. J., Wittkampf, F. H., Hauer, R. N., & Loh, P. (2010). Left atrial volume and function assessment by magnetic resonance imaging. Journal of Cardiovascular Electrophysiology, 21, 1247–1250.PubMedCrossRefGoogle Scholar
  7. 7.
    Abhayaratna, W. P., Seward, J. B., Appleton, C. P., Douglas, P. S., Oh, J. K., Tajik, A. J., et al. (2006). Left atrial size. Physiologic determinants and clinical applications. Journal of the American College of Cardiology, 47, 2357–2363.PubMedCrossRefGoogle Scholar
  8. 8.
    Jarvinen, V., Kupari, M., Hekali, P., & Poutanen, V. P. (1994). Assessment of left atrial volumes and phasic function using cine magnetic resonance imaging in normal subjects. American Journal of Cardiology, 73, 1135–1138.PubMedCrossRefGoogle Scholar
  9. 9.
    Hof, I. E., Velthuis, B. K., Chaldoupi, S. M., Wittkampf, F. H., van Driel, V. J., van der Heijden, J. F., et al. (2011). Pulmonary vein antrum isolation leads to a significant decrease of left atrial size. Europace, 13, 371–375.PubMedCrossRefGoogle Scholar
  10. 10.
    Oral, H., Knight, B. P., Ozaydin, M., Tada, H., Chugh, A., Hassan, S., et al. (2002). Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. Journal of the American College of Cardiology, 40, 100–104.PubMedCrossRefGoogle Scholar
  11. 11.
    Jahnke, C., Fischer, J., Gerds-Li, J. H., Gebker, R., Manka, R., Fleck, E., et al. (2011). Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: A magnetic resonance imaging study. International Journal of Cardiology, 153, 42–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Marsan, N. A., Tops, L. F., Holman, E. R., Van de Veire, N. R., Zeppenfeld, K., Boersma, E., et al. (2008). Comparison of left atrial volumes and function by real-time three-dimensional echocardiography in patients having catheter ablation for atrial fibrillation with persistence of sinus rhythm versus recurrent atrial fibrillation three months later. American Journal of Cardiology, 102, 847–853.PubMedCrossRefGoogle Scholar
  13. 13.
    Tops, L. F., Bax, J. J., Zeppenfeld, K., Jongbloed, M. R., van der Wall, E. E., & Schalij, M. J. (2006). Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. American Journal of Cardiology, 97, 1220–1222.PubMedCrossRefGoogle Scholar
  14. 14.
    Muller, H., Noble, S., Keller, P. F., Sigaud, P., Gentil, P., Lerch, R., et al. (2008). Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace, 10, 1073–1078.PubMedCrossRefGoogle Scholar
  15. 15.
    Perea, R. J., Tamborero, D., Mont, L., De Caralt, T. M., Ortiz, J. T., Berruezo, A., et al. (2008). Left atrial contractility is preserved after successful circumferential pulmonary vein ablation in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19, 374–379.PubMedCrossRefGoogle Scholar
  16. 16.
    Wylie, J. V., Jr., Peters, D. C., Essebag, V., Manning, W. J., Josephson, M. E., & Hauser, T. H. (2008). Left atrial function and scar after catheter ablation of atrial fibrillation. Heart Rhythm, 5, 656–662.PubMedCrossRefGoogle Scholar
  17. 17.
    Liu, Z., Ling, Z., Su, L., Wu, J., Lan, X., Chen, Y., et al. (2008). The effect of different treatment strategies on left atrial size in patients with lone paroxysmal atrial fibrillation—a prospective cohort study. Journal of Interventional Cardiac Electrophysiology, 23, 167–173.PubMedCrossRefGoogle Scholar
  18. 18.
    Hof, I., Arbab-Zadeh, A., Scherr, D., Chilukuri, K., Dalal, D., Abraham, T., et al. (2009). Correlation of left atrial diameter by echocardiography and left atrial volume by computed tomography. Journal of Cardiovascular Electrophysiology, 20, 159–163.PubMedCrossRefGoogle Scholar
  19. 19.
    Hof, I., Arbab-Zadeh, A., Dong, J., Scherr, D., Chilukuri, K., & Calkins, H. (2008). Validation of a simplified method to determine left atrial volume by computed tomography in patients with atrial fibrillation. American Journal of Cardiology, 102, 1567–1570.PubMedCrossRefGoogle Scholar
  20. 20.
    Nori, D., Raff, G., Gupta, V., Gentry, R., Boura, J., & Haines, D. E. (2009). Cardiac magnetic resonance imaging assessment of regional and global left atrial function before and after catheter ablation for atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 26, 109–117.PubMedCrossRefGoogle Scholar
  21. 21.
    Peters, D. C., Wylie, J. V., Hauser, T. H., Kissinger, K. V., Botnar, R. M., Essebag, V., et al. (2007). Detection of pulmonary vein and left atrial scar after catheter ablation with three-dimensional navigator-gated delayed enhancement MR imaging: initial experience. Radiology, 243, 690–695.PubMedCrossRefGoogle Scholar
  22. 22.
    McGann, C. J., Kholmovski, E. G., Oakes, R. S., Blauer, J. J., Daccarett, M., Segerson, N., et al. (2008). New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. Journal of the American College of Cardiology, 52, 1263–1271.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Irene E. Hof
    • 1
  • Evert-Jan Vonken
    • 2
  • Birgitta K. Velthuis
    • 2
  • Fred H. Wittkampf
    • 1
  • Jeroen F. van der Heijden
    • 1
  • Kars G. Neven
    • 1
  • Wil Kassenberg
    • 1
  • Mathias Meine
    • 1
  • Maarten J. Cramer
    • 1
  • Richard N. Hauer
    • 1
  • Peter Loh
    • 1
  1. 1.Department of Cardiology, E03.511University Medical CenterUtrechtThe Netherlands
  2. 2.Department of RadiologyUniversity Medical CenterUtrechtThe Netherlands

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