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

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Abstract

Purpose

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 cm3). 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.

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Abbreviations

AF:

Atrial fibrillation

DE-MRI:

Delayed enhancement magnetic resonance imaging

LA:

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

LAVmax:

Maximal left atrial volume

LAVmid:

Mid left atrial volume

LAVmin:

Minimal left atrial volume

MRI:

Magnetic resonance imaging

PVAI:

Pulmonary vein antrum isolation

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Disclosures

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

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Authors and Affiliations

  1. Department of Cardiology, E03.511, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Irene E. Hof, Fred H. Wittkampf, Jeroen F. van der Heijden, Kars G. Neven, Wil Kassenberg, Mathias Meine, Maarten J. Cramer, Richard N. Hauer & Peter Loh

  2. Department of Radiology, University Medical Center, Utrecht, The Netherlands

    Evert-Jan Vonken & Birgitta K. Velthuis

Authors
  1. Irene E. Hof
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  2. Evert-Jan Vonken
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  3. Birgitta K. Velthuis
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  4. Fred H. Wittkampf
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  5. Jeroen F. van der Heijden
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  6. Kars G. Neven
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  7. Wil Kassenberg
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  8. Mathias Meine
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  10. Richard N. Hauer
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  11. Peter Loh
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Correspondence to Peter Loh.

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Hof, I.E., Vonken, EJ., Velthuis, B.K. et al. Impact of pulmonary vein antrum isolation on left atrial size and function in patients with atrial fibrillation. J Interv Card Electrophysiol 39, 201–209 (2014). https://doi.org/10.1007/s10840-013-9860-0

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  • DOI: https://doi.org/10.1007/s10840-013-9860-0

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