Key result
Cryoballoon PVI plus PWI shows no difference in left atrial mechanical function versus PVI alone.
Why the study?
While PVI alone does not appear to negatively impact left atrial function, the effect of adjunctive posterior wall isolation on left atrial mechanical function has not been definitively determined.
Does pulmonary vein isolation plus posterior wall isolation reduce left atrial mechanical function compared to pulmonary vein isolation alone in patients with atrial fibrillation?
Cohort (n=28)
No
Does pulmonary vein isolation plus posterior wall isolation reduce left atrial mechanical function compared to pulmonary vein isolation alone in patients with atrial fibrillation?
Absolute Event Rate: -0.1% vs -0.3%
The addition of posterior wall isolation to pulmonary vein isolation using a cryoballoon does not adversely impact left atrial mechanical function as measured by cardiac MRI.
No adverse LA function impact with added PWI; leaves open confirmation in randomized trials.
BACKGROUND: Pulmonary vein isolation (PVI) is a cornerstone of AF ablation. Posterior wall isolation (PWI) has become a frequently used adjunct to PVI. While there is data to suggest that PVI alone does not negatively impact left atrial function, the effect of PWI on left atrial mechanical function has not been definitively determined. Our aim was to determine if PVI plus PWI using a cryoballoon impacted left atrial mechanical function as measured by cardiac MRI. METHODS: We studied 28 patients who underwent ablation for AF. Fourteen patients had PVI alone and 14 patients had PVI plus PWI. All patients had cardiac magnetic resonance (CMR) before and after ablation. The primary outcome was change in LA ejection fraction (LAEF) as measured by CMR. RESULTS: There were no statistically significant differences in the average patient age, height, weight, type of AF, or frequency of concomitant diseases between groups. No statistically significant differences in LAEF, LA max volume, LA min volume, or LA stroke volume were identified between baseline and follow up CMRs for the PVI only group nor the PVI plus PWI group. When utilizing linear regression analysis to compare change in LAEF, LA max volume, LA min volume, and LA stroke volume before and after ablation between groups, no statistically significant differences were identified. CONCLUSION: Cardiac MRI did not demonstrate a significant change in left atrial mechanical function as measured by left atrial ejection fraction after pulmonary vein isolation alone nor after PVI plus posterior wall isolation.
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Ellis et al. (2025) conducted a cohort in Atrial fibrillation (n=28). Pulmonary vein isolation plus posterior wall isolation (PVI + PWI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Change in left atrial ejection fraction (LAEF) as measured by CMR. Pulmonary vein isolation plus posterior wall isolation using a cryoballoon did not result in a significant change in left atrial mechanical function compared to pulmonary vein isolation alone.
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