Left Atrial Structural and Functional Changes After Pulmonary Vein Isolation Using Different Energy Sources

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF); however, its impact on long-term left atrial (LA) structural and mechanical remodeling may differ between ablation techniques. Objectives: The aim of this study is to assess changes in LA structure and function after PVI using cryoballoon ablation (CBA) and radiofrequency catheter ablation (RFCA). Methods: Forty-two patients undergoing PVI were prospectively analyzed (CBA, n = 28; RFCA, n = 14). Transthoracic echocardiography with speckle-tracking analysis was performed before PVI and at 12-month follow-up. LA size, volumetric indices (LAVI), strain components, and functional parameters were assessed. Results: Patients undergoing CBA demonstrated greater increases in selected LA structural parameters during follow-up compared with RFCA. Repeated-measures ANOVA revealed a significant group-by-time interaction for LA diameter (p = 0.0017), while similar trends were observed for LAA (p = 0.0645) and LAS-R (p = 0.0547). No significant interaction effects were observed for LAVI-derived parameters or other indices of LA mechanical function. Conclusions: In this preliminary exploratory study, CBA showed a tendency toward greater structural LA remodeling compared with RFCA during a 12-month follow-up. However, these findings should be interpreted with caution given the limited sample size and population heterogeneity. Larger prospective studies are warranted to validate these observations.