Key result
Following pulmonary vein isolation, patients with paroxysmal atrial fibrillation had a higher probability of spherical reverse remodelling compared to those with persistent AF (50.8% vs 29.3%, P=0.03).
Why the study?
Does pulmonary vein isolation improve left atrial sphericity in patients with atrial fibrillation?
Observational (n=102)
Does pulmonary vein isolation improve left atrial sphericity in patients with atrial fibrillation?
Pulmonary vein isolation leads to spherical reverse remodelling in a substantial proportion of patients, particularly those with paroxysmal AF, suggesting left atrial sphericity may be a specific marker for favourable remodelling.
Sphericity may mark favourable LA remodelling after PVI, especially in paroxysmal AF; hypothesis-generating, should not yet change practice.
AIMS: Pulmonary vein isolation (PVI) induces left atrial (LA) volume reduction, known as reverse remodelling (RR). The related changes in LA shape have not yet been evaluated. Left atrial sphericity (LASP) is a new shape-based marker of remodelling that compares LA geometry and a perfect sphere and is a powerful predictor of PVI success. We aimed to evaluate the effect of PVI on LASP and describe the concept of spherical and volumetric RR. METHODS AND RESULTS: Left atrial sphericity and volume were automatically obtained with self-customized software using a magnetic resonance imaging-based three-dimensional reconstruction of LA. Reverse remodelling was defined as improvement in LASP (spherical RR) or volume reduction (volumetric RR). In a series of 102 patients, spherical and volumetric RR was observed in 42.2 and 69%, respectively. Patients with paroxysmal atrial fibrillation (AF) had higher probability to present spherical RR as compared with patients with persistent AF (50.8 vs. 29.3%, P = 0.03). Patients with persistent AF showed significant post-procedural worsening of LASP (81.9 vs. 82.9%, P = 0.04). Patients with no recurrence showed a trend towards a higher proportion of spherical RR compared with those with recurrences (46.2 vs. 32.4%, respectively); no differences were observed in volumetric RR (62.1 vs. 62.9%, respectively). Paroxysmal AF was the only independent predictor of spherical RR. CONCLUSION: Pulmonary vein isolation leads to spherical RR in a substantial proportion of patients, and in higher proportion of patients with paroxysmal AF. Reverse remodelling may be caused by a combination of scarring and myocardial structural recovery. Changes in LASP might be more specific than volume reduction to detect favourable remodelling.
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Bisbal et al. (2014) conducted an observational in Atrial fibrillation (n=102). Paroxysmal atrial fibrillation vs. Persistent atrial fibrillation was evaluated on Spherical reverse remodelling (p=0.03). Following pulmonary vein isolation, patients with paroxysmal atrial fibrillation had a higher probability of spherical reverse remodelling compared to those with persistent AF (50.8% vs 29.3%, P=0.03).
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