Impact of pulmonary vein antrum isolation on left atrial size and function in patients with atrial fibrillation
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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.
KeywordsAtrial fibrillation Left atrium Magnetic resonance imaging Pulmonary vein antrum isolation
Delayed enhancement magnetic resonance imaging
Left atrial/left atrium
- LA active EF
Active left atrial emptying fraction
- LA EF
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.
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